title: Monitored anesthesia care for enucleations and eviscerations.
abstract: OBJECTIVE
  To report the technique and success of using monitored anesthesia care instead of general anesthesia for ocular enucleation and evisceration surgeries.
  
  
  METHODS
  Retrospective, noncomparative interventional case series.
  
  
  METHODS
  Twelve enucleated patients (Soparkar and Patrinely) and 146 eviscerated patients (Kulwin and Kersten).
  
  
  METHODS
  Surgical logs of two oculoplastic practices were reviewed searching for cases of ocular enucleations and eviscerations performed under monitored anesthesia care between 1990 and 2001. Identified hospital and clinic charts were then reviewed.
  
  
  METHODS
  Monitored anesthesia care was deemed successful if (1) there were hemodynamic stability and complete analgesia intraoperatively; (2) there was absence of any chart documentation regarding patient or family psychological distress over the anesthesia method used; and (3) patients were discharged from the hospital without the need for observation or treatment > or = 23 hours.
  
  
  RESULTS
  Between 1990 and 2001, 146 eviscerations were performed under local anesthesia with monitored anesthesia care by two surgeons (RCK, DRK) as their routine practice pattern. In 1996, Drs. Soparkar and Patrinely began performing enucleations under monitored anesthesia care in selected cases, and from 1996 to 2001, these surgeons enucleated 12 patients under monitored anesthesia care. Four of the enucleated patients requested surgery without general anesthesia. The remaining eight patients had been refused surgery by at least one other specialist because of the patient's perceived high medical risk for complications under general anesthesia. In all 158 patients, the procedures were deemed successful by the preceding criteria.
  
  
  CONCLUSIONS
  This four-surgeon case series reports the successful use of local anesthesia with monitored care for ocular enucleation and evisceration procedures, offering several potential advantages over the traditional use of general anesthesia.
authors.affiliation: Department of Ophthalmology, 96 Medical Group Regional Hospital, Eglin AFB, Florida, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Burroughs
authors.forename: Charles N S
authors.initials: CN
authors.lastname: Soparkar
authors.forename: James R
authors.initials: JR
authors.lastname: Patrinely
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kersten
authors.forename: Dwight R
authors.initials: DR
authors.lastname: Kulwin
authors.forename: Chyrl L
authors.initials: CL
authors.lastname: Lowe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005128:Eye Diseases / Q000601:surgery*; D015353:Eye Enucleation; D017234:Eye Evisceration; D006801:Humans; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D005791:Patient Care; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies