title: [Assessment of anesthesiologist intervention during cataract surgery under topical anesthesia].
abstract: OBJECTIVE
  The current demographic situation in France regarding anesthesiologists calls for a reconsideration of anesthesia management for patients undergoing cataract surgery under topical anesthesia. This prospective observational study aimed to assess the requirement for anesthesiologist intervention during cataract surgery performed under topical anesthesia.
  
  
  METHODS
  Patients operated between November 2, 2011 and July 31, 2012 were included after indication of topical anesthesia for phacoemulsification proposed by the surgeon and confirmed by the anesthesiologist. Each patient was premedicated. All patients were monitored and supervised during the surgery by a nurse anesthesiologist. An anesthesiologist could be called at any time at the request of the surgeon or nurse anesthesiologist. For each patient, medical histories were recorded as well as the event "anesthesiologist called", along with the reason and the treatment performed.
  
  
  RESULTS
  Five hundred and seventy-five phacoemulsifications were performed in 486 patients. The event "anesthesiologist called" was recorded 20 times: 18 times for hypertension, once for anxiety and once for non-emergent conversion to general anesthesia after a surgical complication. Each episode of hypertension was successfully treated by following the nicardipine protocol. Preoperatively uncontrolled hypertension was the only significant predictive risk factor for anesthesiologist requirement.
  
  
  CONCLUSIONS
  These results question the usefulness of preoperative anesthesia consultation for all patients who underwent phacoemulsification under topical anesthesia, since this consultation does not lead to an anesthesiologist service. Intraoperative medical complications may be treated according to medical protocols developed jointly by surgeons and anesthesiologists. This practice may free up anesthesiologists' time, without compromising patient safety.
authors.affiliation: Service d'anesthésie-réanimation, pavillon C, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France. Electronic address: lionel.bouvet@chu-lyon.fr.
authors.forename: L
authors.initials: L
authors.lastname: Bouvet
authors.affiliation: Service d'anesthésie-réanimation, pavillon C, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France.
authors.forename: A-L
authors.initials: AL
authors.lastname: Calderon
authors.affiliation: Service d'anesthésie-réanimation, pavillon C, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Augris-Mathieu
authors.affiliation: Service d'anesthésie-réanimation, pavillon C, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France.
authors.forename: N
authors.initials: N
authors.lastname: Diot-Junique
authors.affiliation: Service d'anesthésie-réanimation, pavillon C, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France.
authors.forename: M-P
authors.initials: MP
authors.lastname: Benoit
authors.affiliation: Service d'anesthésie-réanimation, pavillon C, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France.
authors.forename: E
authors.initials: E
authors.lastname: Boselli
authors.affiliation: Service d'ophtalmologie, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France.
authors.forename: J
authors.initials: J
authors.lastname: Fleury
authors.affiliation: Service d'ophtalmologie, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France; Université de Lyon - Claude-Bernard - Lyon 1, 43, boulevard du 11-Novembre-1918, 69100 Villeurbanne, France.
authors.forename: C
authors.initials: C
authors.lastname: Burillon
authors.affiliation: Service d'anesthésie-réanimation, pavillon C, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France; Université de Lyon - Claude-Bernard - Lyon 1, 43, boulevard du 11-Novembre-1918, 69100 Villeurbanne, France.
authors.forename: B
authors.initials: B
authors.lastname: Allaouchiche
mesh_terms: D000368:Aged; D000772:Anesthesia, Local; D000776:Anesthesiology; D005260:Female; D006801:Humans; D008297:Male; D018918:Phacoemulsification; D011446:Prospective Studies
keywords: Ambulatoire; Anesthésie ophtalmologique; Anesthésie topique; Cataract surgery; Chirurgie de la cataracte; Operative risk; Ophthalmologic anesthesia; Outpatient surgery; Quality of care; Qualité des soins; Risque opératoire; Topical anesthesia