title: Local anesthesia with intravenous sedation for surgical repair of selected open globe injuries.
abstract: OBJECTIVE
  To report factors associated with the use of local anesthesia with intravenous sedation (local anesthesia/sedation) rather than general anesthesia for surgery for open globe injuries in adult reparable eyes.
  
  
  METHODS
  Retrospective, nonrandomized, comparative case series.
  
  
  METHODS
  Medical records were reviewed of all patients with open globe injuries repaired at Bascom Palmer Eye Institute between 1995 and 1999. "Adult reparable eyes" (eyes in patients >/=18 years of age, not treated with primary enucleation or evisceration, followed up >/=2 months) were included.
  
  
  RESULTS
  In all, 220 eyes of 218 patients met inclusion criteria. General anesthesia was employed in 80 of 200 (36%) and local anesthesia/sedation in 140 of 220 (64%). Patients who had local anesthesia/sedation were significantly more likely to have an intraocular foreign body (31% vs 14%; P =.010, chi-square test), better presenting visual acuity (1.8 logMAR [logarithm of the minimum angle of resolution] units vs 2.5 logMAR units; P <.001, t test), more anterior wound location (75% corneal/limbal vs 65%; P =.003, chi-square), shorter wound length (6.3mm vs 10.8mm; P <.001, t test), and dehiscence of previous surgical wound (26% vs 12%; P =.021, chi-square) and were significantly less likely to have an afferent pupillary defect (22% vs 51%; P <.001, chi-square). There was no anesthesia-related complication in either group. The local anesthesia/sedation group had a shorter mean operating time than did the general anesthesia group (78 minutes vs 117 minutes; P <.001, t test). The general anesthesia group had a longer mean follow-up than the local anesthesia/sedation group (20.2 months vs 13.9 months, respectively; P =.002, t test). Change in visual acuity between the presenting and final examinations was similar for open globe injuries repaired with general anesthesia compared with local anesthesia/sedation (0.94 vs 0.72 logMAR units of visual acuity, respectively; P =.16, t test).
  
  
  CONCLUSIONS
  Local anesthesia/sedation is a reasonable alternative to general anesthesia for selected patients with open globe injuries.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, School of Medicine, Miami, Florida 33101, USA. iscott@bpei.med.miami.edu
authors.forename: Ingrid U
authors.initials: IU
authors.lastname: Scott
authors.forename: Cathleen M
authors.initials: CM
authors.lastname: Mccabe
authors.forename: Harry W
authors.initials: HW
authors.lastname: Flynn
authors.forename: Dagmar R
authors.initials: DR
authors.lastname: Lemus
authors.forename: Joyce C
authors.initials: JC
authors.lastname: Schiffman
authors.forename: Dale S
authors.initials: DS
authors.lastname: Reynolds
authors.forename: Mauricio B
authors.initials: MB
authors.lastname: Pereira
authors.forename: Armando
authors.initials: A
authors.lastname: Belfort
authors.forename: Steven
authors.initials: S
authors.lastname: Gayer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods; D000771:Anesthesia, Intravenous / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D016292:Procedural Sedation / Q000379:methods*; D005129:Eye Foreign Bodies / Q000601:surgery; D015807:Eye Injuries, Penetrating / Q000601:surgery*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012421:Rupture
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine