title: Anesthesiologist intervention during cataract surgery under topical or peribulbar anesthesia: a propensity model comparison.
abstract: OBJECTIVE
  To compare the incidence and type of anesthesiologist intervention during cataract surgery under peribulbar (PA) or topical (TLA) anesthesia in a day-surgery monitored anesthesia care setting (monitoring provided by nurses with the anesthesiologist available on an on-call basis).
  
  
  METHODS
  From a prospective database of all phacoemulsifications performed in our hospital (January 2008-January 2009), 97 patients submitted to cataract surgery under PA were matched with 97 patients submitted to the same surgery under TA by a propensity model. The resulting groups were homogeneous as to history of antihypertensive therapy administered on the day of surgery and not administered on the day of surgery, cardiologic history, neurologic history, psychiatric history, anxiolytic assumption, and history of diabetes mellitus. We compared the incidence of intervention of the anesthesiologist between groups and the type of adverse event triggering such interventions.
  
  
  RESULTS
  The anesthesiologist was called in 37(38.14%) cases in the PA group and in 27 (27.84%) cases in the TA group (37 [38.14%]) (p = 0.123). Only the occurrence of agitation differed significantly between groups (9 [9.28%] patients in the TA group vs 24 [24.74%] patients in the PA group; p = 0.004).
  
  
  CONCLUSIONS
  Monitored anesthesia care is feasible for cataract surgery both under PA or TA. PA still remains an appealing alternative to TA during cataract surgery for patients incapable of keeping the operating eye in the primary position or with incoercible blinking, photophobia, or phacodonesis. A greater incidence of agitation is to be expected and adequate premedication with anxiolytics should be considered if PA is chosen.
authors.affiliation: Anesthesia & Intensive Care Unit, San Raffaele Scientific Institute, Milano, Italy. gemma.marco@hsr.it
authors.forename: Marco
authors.initials: M
authors.lastname: Gemma
authors.forename: Luigi
authors.initials: L
authors.lastname: Gioia
authors.forename: Elisa
authors.initials: E
authors.lastname: Dedola
authors.forename: Benedetta
authors.initials: B
authors.lastname: Basta
authors.forename: Ingrid
authors.initials: I
authors.lastname: Bianchi
authors.forename: Francesco
authors.initials: F
authors.lastname: Fasce
authors.forename: Luigi
authors.initials: L
authors.lastname: Beretta
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002387:Cataract Extraction; D005260:Female; D006801:Humans; D007267:Injections; D007430:Intraoperative Care / Q000379:methods*; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D016343:Monitoring, Intraoperative; D009915:Orbit; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine