Gemma Marco, Gioia Luigi, Dedola Elisa, Basta Benedetta, Bianchi Ingrid, Fasce Francesco, Beretta Luigi
Anesthesia & Intensive Care Unit, San Raffaele Scientific Institute, Milano, Italy.
Eur J Ophthalmol. 2010 Jul-Aug;20(4):687-93. doi: 10.1177/112067211002000408.
To compare the incidence and type of anesthesiologist intervention during cataract surgery under peribulbar (PA) or topical (TLA) anesthesia in a day-surgery monitored anesthesia care setting (monitoring provided by nurses with the anesthesiologist available on an on-call basis).
From a prospective database of all phacoemulsifications performed in our hospital (January 2008-January 2009), 97 patients submitted to cataract surgery under PA were matched with 97 patients submitted to the same surgery under TA by a propensity model. The resulting groups were homogeneous as to history of antihypertensive therapy administered on the day of surgery and not administered on the day of surgery, cardiologic history, neurologic history, psychiatric history, anxiolytic assumption, and history of diabetes mellitus. We compared the incidence of intervention of the anesthesiologist between groups and the type of adverse event triggering such interventions.
The anesthesiologist was called in 37(38.14%) cases in the PA group and in 27 (27.84%) cases in the TA group (37 [38.14%]) (p = 0.123). Only the occurrence of agitation differed significantly between groups (9 [9.28%] patients in the TA group vs 24 [24.74%] patients in the PA group; p = 0.004).
Monitored anesthesia care is feasible for cataract surgery both under PA or TA. PA still remains an appealing alternative to TA during cataract surgery for patients incapable of keeping the operating eye in the primary position or with incoercible blinking, photophobia, or phacodonesis. A greater incidence of agitation is to be expected and adequate premedication with anxiolytics should be considered if PA is chosen.
在日间手术监测麻醉护理环境下（由护士进行监测，麻醉医生随时待命），比较球周麻醉（PA）或表面麻醉（TLA）下白内障手术期间麻醉医生干预的发生率及类型。
从我院所有超声乳化白内障吸除术的前瞻性数据库（2008年1月至2009年1月）中，通过倾向模型将97例行PA下白内障手术的患者与97例行TA下相同手术的患者进行匹配。所得两组在手术当天接受或未接受抗高血压治疗的病史、心脏病史、神经病史、精神病史、抗焦虑药物使用情况以及糖尿病史方面具有同质性。我们比较了两组之间麻醉医生的干预发生率以及引发此类干预的不良事件类型。
PA组有37例（38.14%）患者呼叫了麻醉医生，TA组有27例（27.84%）患者呼叫了麻醉医生（37例[38.14%]）（p = 0.123）。两组之间仅激越的发生率存在显著差异（TA组9例[9.28%]患者 vs PA组24例[24.74%]患者；p = 0.004）。
监测麻醉护理对于PA或TA下的白内障手术均可行。对于无法将术眼保持在原位或存在无法控制的眨眼、畏光或晶状体震颤的患者，PA在白内障手术期间仍是TA的一个有吸引力的替代方案。如果选择PA，预计激越的发生率会更高，应考虑使用抗焦虑药物进行充分的术前用药。
