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Schein OD, Friedman DS, Fleisher LA, et al. Anesthesia Management During Cataract Surgery. Rockville (MD): Agency for Healthcare Research and Quality (US); 2001 Dec. (Evidence Reports/Technology Assessments, No. 16.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

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Anesthesia Management During Cataract Surgery.

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5Future Research

Based on our findings, we hope that future research will pay more detailed attention to important methodologic considerations. Although the relative importance of specific recommendations in this area depends on the precise question being addressed, we suggest that greater attention be devoted to (1) ensuring the representativeness of the study population (e.g., consecutive patients or the use of a specified sampling frame, and the use of data from multiple surgeons); (2) the specification of study exclusions, if any; (3) the preoperative medical and ophthalmic characteristics of the study population; (4) the description of the surgical technique, including both the mean and distribution of surgery times; (5) the use of outcomes that have been clearly defined; and 6) the actual distribution (rather than just means) of patient reports of pain, satisfaction, etc.

We identified two significant gaps in the content of literature. First, there is insufficient incorporation of patient perceptions of and preferences for different anesthesia and sedation techniques. Relevant patient perspectives that might be addressed in the same randomized study might include not only pain but also anxiety, drowsiness, and nausea. Learning patient preferences for specific tradeoffs (e.g., greater awareness of surgery with topical anesthesia versus more rapid recovery of vision) would be very valuable in trying to assess optimal or preferred strategies for both local anesthesia and sedation.

The second major gap relates to the cost effectiveness of different management strategies. The most obvious example relates to the use of intravenous sedation with associated monitoring by an anesthesiologist. Almost no research directly addressed the value of anesthesiologists/nurse anesthetists and intravenous sedation during cataract surgery. One article reviewed (Pecka and Dexter, 1997) and another published after the close of our review process (Rosenfeld, Litinsky, Snyder et al., 1999) claim a benefit to the presence of an anesthesia professional based on the frequency of reported intraoperative interventions (e.g., the administration of an antihypertensive). However, these reports used no control groups and did not show any actual benefit to patient health. Furthermore, preliminary data from the Study of Medical Testing for Cataract Surgery suggest that the use of intravenous agents is associated with higher rates of intraoperative adverse medical events (e.g., treatment for hypertension or arrhythmia) than when such agents are not used. In light of the significant costs associated with monitored anesthesia care, uncertainty regarding the existence or magnitude of its benefit to patients, the value that patients place on the services, and the significant national and international variation in the use of intravenous sedation and monitoring by an anesthesia professional, we believe that this is an important area for future study.

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