Heard Jarrett A, Zacarias Alicia A Gonzalez, Lawrence Alec T, Stoicea Nicoleta, Palettas Marilly, Fiorda-Diaz Juan, Guertin Michael G, Tandon Amit, Lowery Deborah S
Department of Anesthesiology.
Department of Biomedical Informatics, Center for Biostatistics.
Medicine (Baltimore). 2020 Nov 20;99(47):e21834. doi: 10.1097/MD.0000000000021834.
Cataract surgery is the most common ambulatory surgery at our outpatient surgery center. Several studies have shown that patients with bilateral cataracts may experience different levels of anxiety, pain, and awareness during the first and second cataract extraction.A prospective observational cohort study was conducted at The Ohio State University Wexner Medical Center Eye and Ear Institute in order to compare anxiety, general comfort, awareness, and pain levels in patients undergoing sequential cataract surgeries. Likert and numerical rating scale were used to assess the outcomes. Patients receiving monitored anesthesia care and topical anesthesia were included.A total of 198 patients were enrolled in this study, 116 patients (59%) were female and 157 patients (78%) were Caucasians with a median age of 67 years among participants. Patients with rating "no anxiety" or feeling "somewhat anxious" were significantly higher during surgery 2 (P =< .001). Most of the patients felt "extremely comfortable" during surgery 1 when compared to surgery 2 (54% vs 42.9%; P = .08). No significant differences were found between surgeries regarding intraoperative awareness (P = .16). Overall, patients experienced mild pain during both procedures (92.4% in surgery 1 compared to 90.4% in surgery 2; P = .55). During the postoperative visit, 54% of the patients associated surgery 2 with less anxiety levels, 53% with no differences in general comfort, 60% felt more aware, and 59% had no differences in pain levels.Previous exposure to surgery could have been associated with a significant reduction in anxiety levels reported during surgery 2. Non-pharmacological strategies aiming to reduce perioperative anxiety may be considered an alternative or additional approach to premedication in patients undergoing consecutive cataract surgeries.
白内障手术是我们门诊手术中心最常见的非住院手术。多项研究表明，双侧白内障患者在首次和第二次白内障摘除手术期间可能会经历不同程度的焦虑、疼痛和清醒状态。俄亥俄州立大学韦克斯纳医学中心眼耳研究所开展了一项前瞻性观察队列研究，以比较接受连续白内障手术患者的焦虑、总体舒适度、清醒状态和疼痛程度。采用李克特量表和数字评定量表评估结果。纳入接受监护麻醉护理和局部麻醉的患者。本研究共纳入198例患者，其中116例（59%）为女性，157例（78%）为白种人，参与者的中位年龄为67岁。在手术2期间，评定为“无焦虑”或感觉“有点焦虑”的患者比例显著更高（P≤0.001）。与手术2相比，大多数患者在手术1期间感觉“极其舒适”（54%对42.9%；P = 0.08）。手术之间在术中清醒状态方面未发现显著差异（P = 0.16）。总体而言，患者在两个手术过程中均经历轻度疼痛（手术1为92.4%，手术2为90.4%；P = 0.55）。在术后随访中，54%的患者认为手术2的焦虑程度较低，53%的患者认为总体舒适度无差异，60%的患者感觉更清醒，59%的患者疼痛程度无差异。既往手术经历可能与手术2期间报告的焦虑程度显著降低有关。对于接受连续白内障手术的患者，旨在降低围手术期焦虑的非药物策略可被视为术前用药的替代或补充方法。
