Fernandes Manuela Bezerril Cipião, Souza Rodrigo Vicentini Fernandes de, Vasconcelos Gregório Carolino, Ribeiro Kérsia Gomes, Andrade Bruno Bezerril, Fernandes Cláudia Regina
Arq Bras Oftalmol. 2013 Nov-Dec;76(6):345-9. doi: 10.1590/s0004-27492013000600005.
Ocular akinesia, the use of anticoagulants, and patient collaboration are some of the factors that must be taken into consideration when choosing the appropriate anesthesia for phacoemulsification cataract surgery. The satisfaction of patients with the use of topical anesthesia and conscious sedation for this procedure has not been enough described in Brazil. Conscious sedation allows patient walk and answer a voice command. To assess the satisfaction, pain, and perioperative hemodynamic alterations of patients subjected to phacoemulsification under conscious sedation and topical anesthesia supplemented with intracameral lidocaine.
Prospective cohort non-controlled study that included patients treated by the same surgical team over a 70-day period. Sedation was performed with midazolam at a total dose of 3 mg and topical anesthesia with 0.5% proxymetacaine chlorhydrate and 2% lidocaine gel combined with 2% lidocaine by intracameral route. The intraoperative vital parameters, scores based on the Iowa Satisfaction with Anesthesia Scale (ISAS), and the pain visual analog scale (VAS) were recorded at several time points after surgery.
A total of 106 patients were enrolled in study (73.6% female), the mean age was 65.9 years. The surgical procedures lasted 11.2 minutes on average. The hemodynamic parameters did not exhibit significant changes at any of the investigated time points. The average ISAS score was 2.67 immediately after surgery and 2.99 eight hours after the surgery; this increase was statistically significant (p<0.0001). More than two-thirds (68.9%) of the participants (73 patients) did not report any pain in the transoperative period, and 98.1% of patients denied the occurrence of pain after surgery.
Patients that received topical anesthesia supplemented by intracameral lidocaine combined with sedation for phacoemulsification cataract surgery reported adequate level of satisfaction with the anesthetic choice. Furthermore, the patients exhibited hemodynamic parameter stability and pain control.
眼球运动不能、抗凝剂的使用以及患者的配合度是选择白内障超声乳化手术合适麻醉方式时必须考虑的一些因素。在巴西，关于局部麻醉联合清醒镇静用于该手术的患者满意度尚未得到充分描述。清醒镇静使患者能够行走并听从语音指令。本研究旨在评估在清醒镇静及局部麻醉联合前房内注射利多卡因下接受超声乳化手术患者的满意度、疼痛及围手术期血流动力学改变。
前瞻性队列非对照研究，纳入同一手术团队在70天内治疗的患者。使用咪达唑仑进行镇静，总剂量为3mg，局部麻醉采用0.5%盐酸丙美卡因和2%利多卡因凝胶联合前房内注射2%利多卡因。记录术后多个时间点的术中生命体征参数、基于爱荷华麻醉满意度量表（ISAS）的评分以及疼痛视觉模拟量表（VAS）评分。
共纳入106例患者（73.6%为女性），平均年龄65.9岁。手术平均持续11.2分钟。在任何研究时间点，血流动力学参数均未出现显著变化。术后即刻平均ISAS评分为2.67，术后8小时为2.99；这种增加具有统计学意义（p<0.0001）。超过三分之二（68.9%）的参与者（73例患者）在手术过程中未报告任何疼痛，98.1%的患者否认术后出现疼痛。
接受局部麻醉联合前房内注射利多卡因及镇静进行白内障超声乳化手术的患者对麻醉选择的满意度较高。此外，患者血流动力学参数稳定且疼痛得到控制。
