Role of the anaesthetist during cataract surgery under local anaesthesia in the UK: a national survey

Abstract

Recent advances in cataract surgery techniques have enabled these to be performed under less invasive local anaesthetic techniques. As a result, ophthalmic surgeons are increasingly prepared to give the local anaesthesia to the patient themselves without the need for the presence of an anaesthetist. A national postal survey was conducted in 2008, asking all consultant ophthalmic surgeons for their choice of local anaesthetic technique, whether an anaesthetist or a surgeon performs the block, the current level of anaesthetic cover for the ophthalmic operating sessions, and the need for anaesthetists for phacoemulsification under local anaesthesia in future. No reminders were sent to the non-respondents. The response rate was 62%. The choice of local anaesthetic technique was sub-Tenon's 47%, topical 33%, peribulbar 16%, retrobulbar 2%, and others 2%. Twenty-eight per cent of sub-Tenon's blocks were given by the surgeons and 47% by the anaesthetists. Of peribulbar blocks, 9% were given by the surgeons and 85% by the anaesthetist. Seventy-five per cent of ophthalmic operating sessions had allocated anaesthetic cover. Ophthalmic surgeons felt that in their judgement, only 10% of the phacoemulsifications under local anaesthesia would necessitate the presence of an anaesthetist. The consultant eye surgeons, based on their judgement, are prepared to undertake a bigger proportion of cataract surgeries under local anaesthesia without the presence of an anaesthetist. This development is bound to have a significant impact on manpower planning for ophthalmic anaesthetists.