Effectiveness of monitored anesthesia care in cataract surgery
Effectiveness of monitored anesthesia care in cataract surgery
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DOI：
10.1016/s0161-6420(99)00705-8
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发表时间：
1999-07-01
期刊：
影响因子：
13.7
通讯作者：
Schiffman, J
中科院分区：
文献类型：
--
作者：
Rosenfeld, SI;Litinsky, SM;Schiffman, J
目的：通过评估麻醉人员干预的发生率和寻找相关的危险因素，确定白内障手术中是否需要监测麻醉护理。设计：非随机、前瞻性病例系列，分析连续性白内障手术病例。参与者：在门诊手术中心连续6个月内接受白内障手术的1006例患者。方法：在局部麻醉下对患者进行常规白内障手术。在白内障手术的每个阶段（术前、术中和术后）结束时，由麻醉人员完成详细的问卷调查。主要结果测量：年龄、病史和术前心电图（EKG）作为麻醉人员干预的预测因素进行分析。病人的问题和麻醉人员的干预类型的性质recorded.Results：在1006例连续白内障手术中，麻醉人员的干预需要在376例（37.4%）。没有发现术前识别特征是需要干预的可靠预测因素。接受干预的患者与未接受干预的患者之间的术前EKG和一些医疗状况（如心脏病、糖尿病和甲状腺疾病）无统计学显著差异。某些患者亚组的干预发生率确实在统计学上显着增加，包括全身性高血压患者（41.4%）与非高血压患者相比（34.5%）（P = 0.030），肺部疾病患者（49.3%）vs无肺部疾病（36.5%）（P = 0.043），肾病患者（68.8%）与无肾脏疾病（36.9%）（P = 0.019），以及癌症患者（61.9%）与无癌症患者（36.3%）（P = 0.001）。61.1%的60岁以下患者需要干预，而60岁及以上患者需要干预的比例为36.5%（P = 0.005）。由于超过三分之一的白内障手术病例需要干预，作者无法可靠地预测这些患者的风险，在局部麻醉下的白内障手术中，监测麻醉护理似乎是合理的。
Objective: To determine the need for monitored anesthesia care in cataract surgery by evaluating the incidence of intervention by anesthesia personnel and by looking for associated risk factors.Design: Nonrandomized, prospective case series with analysis of consecutive cataract surgery cases.Participants: A total of 1006 consecutive cataract surgery patients at an ambulatory surgery center over a 6-month period.Methods: Routine cataract surgery was performed with the patient under local anesthesia. A detailed questionnaire was completed by the anesthesia personnel at the conclusion of each phase (before, during, and after) of cataract surgery.Main Outcome Measures: Age, medical history, and preoperative electrocardiogram (EKG) were analyzed as predictors for intervention by anesthesia personnel. The nature of the patient's problem and the type of intervention by anesthesia personnel were recorded.Results: In 1006 consecutive cataract surgery cases, intervention by anesthesia personnel was required in 376 (37.4%) cases. No preoperative identifying characteristics were found to be reliable predictors of the need for intervention. There were no statistically significant differences in preoperative EKG and some medical conditions such as heart disease, diabetes, and thyroid disease between patients who received intervention and those who did not. Certain subgroups of patients did show a statistically significantly greater incidence of intervention, including systemic hypertensives (41.4%) versus nonhypertensives (34.5%) (P = 0.030), patients with pulmonary disease (49.3%) versus no pulmonary disease (36.5%) (P = 0.043), patients with renal disease (68.8%) versus no renal disease (36.9%) (P = 0.019), and patients with cancer (61.9%) versus no cancer (36.3%) (P = 0.001). Intervention was also required in 61.1% of patients younger than 60 years of age compared to 36.5% of those patients 60 years of age and older (P = 0.005).Conclusions: Because intervention is required in more than one third of cataract surgery cases and the authors cannot reliably predict those patients at risk, monitored anesthesia care seems justified in cataract surgery with the patient under local anesthesia.