Establishing Rapport and Assessing Medical Conditions
Preoperative testing should be based on the history and physical examination.
Many elderly adult candidates for ophthalmic surgery are on antiplatelet or anticoagulant therapy owing to a history of coronary or vascular pathology. Continuing warfarin therapy for cataract extraction may be associated with an increased risk of bleeding (self-limiting and not clinically relevant).
The risk of thrombotic complications in patients with drug-eluting stents appears to outweigh the risk of bleeding complications (continue dual antiplatelet therapy in the perioperative period). A recommendation is to delay elective surgery for at least 4 to 6 weeks after placement of a bare metal stent and for at least 12 months after drug-eluting stent placement.
Despite the possibility of eye injury from patient movement in the event of implanted cardiac defibrillator activation, there are no reports of activation during ophthalmic surgery, and magnets to inactivate the device before surgery are rarely used.
Perioperative movement is a possible cause of patient eye injury and potential anesthesiologist liability. Inadequate sedation during monitored anesthesia care (MAC) may be associated with unpredictable movement that results in blindness or poor visual outcome. Intraoperative movement during general anesthesia may also result in adverse visual consequences.
Anesthesia Options. A commonly selected regional anesthetic technique for cataract surgery is peribulbar block (which has a better safety profile than retrobulbar block). Topical anesthesia is also effective for cataract surgery.
Side of Anesthesia and Surgery. Ophthalmologic surgery and regional anesthesia confer greater risk than many other surgical procedures owing to the potential for laterality errors.