Model of anesthesia care that combines anesthesiologists and registered nurses during cataract surgery.
OBJECTIVE
To determine the safety and practicality of a combined anesthesiologist and registered nurse model of anesthesia care in cataract surgery.


METHODS
Mayo Clinic, Rochester, Minnesota, USA.


METHODS
Case series.


METHODS
This retrospective review comprised consecutive patients having phacoemulsification cataract surgery and peribulbar injection anesthesia combined with propofol intravenous sedation between August 1, 2004, and July 31, 2006. In all cases, anesthesiologist-supervised intravenous propofol sedation during injection anesthesia was followed by registered nurse observation for the remainder of the surgery. Outcome measures were the rate of subsequent anesthesiologist intervention, intraoperative complications, and associated risk factors. Logistic regression models were used to estimate risk for anesthesiologist intervention.


RESULTS
The study reviewed 3656 cases. There were no serious medical complications leading to postoperative hospitalization. Fifty-four cases (1.5%) required subsequent intraoperative anesthesiologist intervention. Evaluation of systolic hypertension (40 of 54 cases, 74%) was the most common reason for anesthesiologist intervention. There was no correlation between anesthesiologist intervention and patient age or sex (P=.77 and P=.41, respectively). The risk for anesthesiologist intervention increased 2.2-fold for every 1 unit increase in the American Society of Anesthesiologists Physical Status score (P=.007).


CONCLUSIONS
The monitoring of cataract surgery patients by registered nurses after anesthesiologist-supervised intravenous propofol sedation during injection anesthesia was associated with very low complication and anesthesiologist intervention rates.
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA. erie.jay@mayo.edu
Andrew J
AJ
Erie
Ryan
R
McHugh
Mary
M
Warner
Jay C
JC
Erie
D000368:Aged; D000776:Anesthesiology / Q000458:organization & administration*; D000779:Anesthetics, Local / Q000008:administration & dosage; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007431:Intraoperative Complications; D008297:Male; D016343:Monitoring, Intraoperative; D009719:Nurse Anesthetists / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D018918:Phacoemulsification; D015742:Propofol / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors
D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D015742:Propofol