title: Adverse intraoperative medical events and their association with anesthesia management strategies in cataract surgery.
abstract: OBJECTIVE
  To compare adverse medical events by different anesthesia strategies for cataract surgery.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Patients 50 years of age and older undergoing 19,250 cataract surgeries at nine centers in the United States and Canada between June 1995 and June 1997.
  
  
  METHODS
  Local anesthesia applied topically or by injection, with or without oral and intravenous sedatives, opioid analgesia, hypnotics, and diphenhydramine (Benadryl).
  
  
  METHODS
  Intraoperative and postoperative adverse medical events.
  
  
  RESULTS
  Twenty-six percent of surgeries were performed with topical anesthesia and the remainder with injection anesthesia. There was no increase in deaths and hospitalizations associated with any specific anesthesia strategy. No statistically significant difference was observed in the prevalence of intraoperative events between topical and injection anesthesia without intravenous sedatives (0.13% and 0.78%, respectively). The use of intravenous sedatives was associated with a significant increase in adverse events for topical (1.20%) and injection anesthesia (1.18%), relative to topical anesthesia without intravenous sedation. The use of short-acting hypnotic agents with injection anesthesia was also associated with a significant increase in adverse events when used alone (1.40%) or in combination with opiates (1.75%), sedatives (2.65%), and with the combination of opiates and sedatives (4.04%). These differences remained after adjusting for age, gender, duration of surgery, and American Society of Anesthesiologists risk class.
  
  
  CONCLUSIONS
  Adjuvant intravenous anesthetic agents used to decrease pain and alleviate anxiety are associated with increases in medical events. However, cataract surgery is a safe procedure with a low absolute risk of medical complications with either topical or injection anesthesia. Clinicians should weigh the risks and benefits of their use for individual patients.
authors.affiliation: Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205-2103, USA.
authors.forename: J
authors.initials: J
authors.lastname: Katz
authors.forename: M A
authors.initials: MA
authors.lastname: Feldman
authors.forename: E B
authors.initials: EB
authors.lastname: Bass
authors.forename: L H
authors.initials: LH
authors.lastname: Lubomski
authors.forename: J M
authors.initials: JM
authors.lastname: Tielsch
authors.forename: B G
authors.initials: BG
authors.lastname: Petty
authors.forename: L A
authors.initials: LA
authors.lastname: Fleisher
authors.forename: O D
authors.initials: OD
authors.lastname: Schein
mesh_terms: D000759:Adjuvants, Anesthesia / Q000009:adverse effects*; D000287:Administration, Topical; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D000772:Anesthesia, Local / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002387:Cataract Extraction; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D007267:Injections; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000759:Adjuvants, Anesthesia; D000700:Analgesics; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives