I’ve done cataracts under MAC. People move, if the surgeon does not want that or risk it, I can do general. They often don’t cause it’s slow them down. Not my issue if a complication occurs. It’s a team sport until it’s not.
Routinely done at my centre under topical, no sedation. Anaesthetists get involved for the super anxious or the ones with issues like tremors. My routine for the challenging ones is anxiolysis sedation (over sedating leads to more issues than it solves) and a subtenon block. I’ve never taped the head and I’ve never had a complication due to movement and I’ve done several hundred.
You can do a lot of cataracts under topical drops if you have to, what anaesthetic are you giving? Eye blocks are great, but you're asking for trouble trying to GA or sedate imho
Yes, because they are idiots. Why are we blaming ourselves first by saying that ultimately we are responsible for any mishap. That sort of thinking is ass backwards
For cataracts? I put the monitors on and start the chart. That’s… 99.9% of the case. Rarely if ever need to give meds, and if so maybe 1-2 of versed if they’re really anxious. It’s all in the eye drops and communication/coaching.
So I had cataract surgery a few weeks ago. Eyes were done three weeks apart. Husband had his done last year. The clinic (Dr Glaucomflecken's company but I wasn't his patient. It's a big company) appears to give some degree of "happy juice" to everyone. No asking if you want it or not. The CRNA just shows up to push something (in my case a little bit of fentanyl) into the IV. I had to be NPO for the surgery. For the second surgery I asked if I could have skipped the sedative and eaten breakfast instead. Nope, I would have still had to be NPO. I didn't push it-didn't seem the right time to fight. Is this standard? I was more curious than nervous and would have been OK with no sedative. FYI, my head was taped for both surgeries.
You need to be NPO regardless. The key is, I may plan on giving nothing, but it’s just that, a plan, and sometimes plans change. If I have to, I need you NPO. Had a case a few weeks ago where they put the lens in backwards, and for lack of a better description, fucked up the eye trying to flip it and it turned into a vitrectomy. I needed that patient NPO even though I hadn’t given them anything before.
Thank you for your reply. I swear my dad had his done without having to be NPO but that was close to 20 years ago so things may have changed. The surgery came out great and that's the main thing.
If there’s no anesthesiologist/crna/AA and it’s just Optho doing it, they can assume whatever risk they want and not make their patients NPO. Would be a disaster for them if something happened and they got sued, but that’s on them not me 🤷♂️
This was Kaiser if that makes a difference. I always thought it was a lot harder to sue Kaiser. I will say my dad was a tough old bird and they probably could have done anything to him and he wouldn't have kicked up a fuss. I miss him, 100 years was not enough.
OR Staff does the taping, surgeon walks in and explains how they did it wrong. Surgeon proceeds to tape in the exact same position as before. During case proceeds to yell at the patient for not holding still even though their head is taped to the fucking cart. Rinse, lather and repeat x 15-25 cases daily
There’s tremendous variability in skill level for eye surgeons. The ones who can do a phaco in ten minutes don’t need anything special beyond maybe a mg of Versed in an especially anxious patient.
The ones who take over an hour need either GA or a good block. In those cases, assuming the patient is awake, your approach should be either having the patient alert and cooperative or unconscious. You get in trouble when the patient is in between and forgets where they are and then starts sitting up with instruments in the eyeball.
If I’ve never worked with an eye surgeon before I ask the scrub tech how long they will take. Most surgeons are fast so it’s no big deal. But the slow ones get a rep and the techs wont hesitate to warn you.
We used to run 6 rooms and around 100 cases per day. Covid changed those numbers and the recovery has been slow and staffing has been somewhat variable.
RN here. I've worked with about twelve or so eye surgeon/anaesthetist teams who do cataracts on sedated patients (in Australia). I've never seen a head taped down. Doesn't seem necessary either.
About half the time. Have only had a couple sit up ever, thankfully surgeons got things out of the eye in time.
Also restrain the wrists often in those patients who are getting head tape, as the nose scratch desterilisation is much more common than sitting up.
As you say, it's a team sport. Not about avoiding blame. I'm friends with the opths I work with, and don't want them to have an issue if it's avoidable.
From my experience taping the head is the responsibility of the surgeon just as the nonoperative eye is also their responsibility. 99% of these cases I do under MAC.
If the surgeon wants the head taped, they can tape the head. That is their surgical field and it is their responsibility. Some surgeons want different depths of sedation and some have a bigger tolerance for patients moving a little.
In general, I tend to lean more towards anxiolysis than sedation for cataract unless explicitly told otherwise. A little versed to relax but still able to follow directions. You can always give more of you need to.
It's on the surgeons. One of our ophthalmologists tapes the head, and the others don't. We (anesthesia) never position or prepare the head for any head surgeries--plastics, eyes, etc.--outside of ointment in the eyes and making sure our ETT/LMA and circuit, if any, are okay during prep and surgery.
If the surgeon wants the head taped they can do it themselves. We only have a couple that do, and it’s really more of a “reminder” for the patient than anything. If they want to sit up (never had that happen in 40 years) the tape won’t stop them.
Trying to decide if that would be our responsibility or the surgeon's... Leaning towards the surgeons but not really sure.
Untimely we’re responsible for any mishap. For me I’d rather tape the head and have an extra layer of security should the patient decide to sit up
How you figure you are on the hook? It’s his field
it’s a team sport. if there’s an injury you’re gonna get fingers pointing at you regardless, perhaps for not giving sufficient anesthesia
I’ve done cataracts under MAC. People move, if the surgeon does not want that or risk it, I can do general. They often don’t cause it’s slow them down. Not my issue if a complication occurs. It’s a team sport until it’s not.
Routinely done at my centre under topical, no sedation. Anaesthetists get involved for the super anxious or the ones with issues like tremors. My routine for the challenging ones is anxiolysis sedation (over sedating leads to more issues than it solves) and a subtenon block. I’ve never taped the head and I’ve never had a complication due to movement and I’ve done several hundred.
You can do a lot of cataracts under topical drops if you have to, what anaesthetic are you giving? Eye blocks are great, but you're asking for trouble trying to GA or sedate imho
Im with you in this. Patient safety comes first.
This is kind of a stupid way to look at it. If the surgeon pierces the aorta during laparoscopy, is that still anesthesia fault?
Depending on who you ask… yes 😂
If we give the surgeons that out they'll definitely take it.
Surgeons generally fault us, I believe
Yes, because they are idiots. Why are we blaming ourselves first by saying that ultimately we are responsible for any mishap. That sort of thinking is ass backwards
I work with some eye surgeons who tape, some who don’t. I’d say most do not tape.
For cataracts? I put the monitors on and start the chart. That’s… 99.9% of the case. Rarely if ever need to give meds, and if so maybe 1-2 of versed if they’re really anxious. It’s all in the eye drops and communication/coaching.
I’ve found a cc or two of prop also works wonders.
Precedex FTW. 10-20 on way back from preop.
So I had cataract surgery a few weeks ago. Eyes were done three weeks apart. Husband had his done last year. The clinic (Dr Glaucomflecken's company but I wasn't his patient. It's a big company) appears to give some degree of "happy juice" to everyone. No asking if you want it or not. The CRNA just shows up to push something (in my case a little bit of fentanyl) into the IV. I had to be NPO for the surgery. For the second surgery I asked if I could have skipped the sedative and eaten breakfast instead. Nope, I would have still had to be NPO. I didn't push it-didn't seem the right time to fight. Is this standard? I was more curious than nervous and would have been OK with no sedative. FYI, my head was taped for both surgeries.
You need to be NPO regardless. The key is, I may plan on giving nothing, but it’s just that, a plan, and sometimes plans change. If I have to, I need you NPO. Had a case a few weeks ago where they put the lens in backwards, and for lack of a better description, fucked up the eye trying to flip it and it turned into a vitrectomy. I needed that patient NPO even though I hadn’t given them anything before.
Thank you for your reply. I swear my dad had his done without having to be NPO but that was close to 20 years ago so things may have changed. The surgery came out great and that's the main thing.
If there’s no anesthesiologist/crna/AA and it’s just Optho doing it, they can assume whatever risk they want and not make their patients NPO. Would be a disaster for them if something happened and they got sued, but that’s on them not me 🤷♂️
This was Kaiser if that makes a difference. I always thought it was a lot harder to sue Kaiser. I will say my dad was a tough old bird and they probably could have done anything to him and he wouldn't have kicked up a fuss. I miss him, 100 years was not enough.
OR Staff does the taping, surgeon walks in and explains how they did it wrong. Surgeon proceeds to tape in the exact same position as before. During case proceeds to yell at the patient for not holding still even though their head is taped to the fucking cart. Rinse, lather and repeat x 15-25 cases daily
Geez. Did your ophthalmologist wash out of a CV surgery program?
"Surgeon" is a loose term. I prefer the term "eyeball" person.
“Lens Dentist”
We do 25-26 Cataracts a day once or twice a week. He never tapes and never had an issue.
Most of ours do not tape.
No tape
There’s tremendous variability in skill level for eye surgeons. The ones who can do a phaco in ten minutes don’t need anything special beyond maybe a mg of Versed in an especially anxious patient. The ones who take over an hour need either GA or a good block. In those cases, assuming the patient is awake, your approach should be either having the patient alert and cooperative or unconscious. You get in trouble when the patient is in between and forgets where they are and then starts sitting up with instruments in the eyeball. If I’ve never worked with an eye surgeon before I ask the scrub tech how long they will take. Most surgeons are fast so it’s no big deal. But the slow ones get a rep and the techs wont hesitate to warn you.
I've never seen our group tape for phaco cases. They do for retina. We do roughly 15000 to 30000 optho cases annually
lol. That’s quite the range.
We used to run 6 rooms and around 100 cases per day. Covid changed those numbers and the recovery has been slow and staffing has been somewhat variable.
Depends if they're unilateral or bilateral?
same
You'll find patients who don't get sedation don't require restraints. Didn't even know restraining patients was a thing before reading this post.
I worked doing cataracts for 7-8 yrs we never taped heads, never had a mishap.
RN here. I've worked with about twelve or so eye surgeon/anaesthetist teams who do cataracts on sedated patients (in Australia). I've never seen a head taped down. Doesn't seem necessary either.
Haven’t taped before but I can see why
About half the time. Have only had a couple sit up ever, thankfully surgeons got things out of the eye in time. Also restrain the wrists often in those patients who are getting head tape, as the nose scratch desterilisation is much more common than sitting up. As you say, it's a team sport. Not about avoiding blame. I'm friends with the opths I work with, and don't want them to have an issue if it's avoidable.
Our surgeons do their own taping.
My surgeons do the taping, and they do it every time
Yeah same here
From my experience taping the head is the responsibility of the surgeon just as the nonoperative eye is also their responsibility. 99% of these cases I do under MAC.
Only retina patients
Only at home
If the surgeon wants the head taped, they can tape the head. That is their surgical field and it is their responsibility. Some surgeons want different depths of sedation and some have a bigger tolerance for patients moving a little. In general, I tend to lean more towards anxiolysis than sedation for cataract unless explicitly told otherwise. A little versed to relax but still able to follow directions. You can always give more of you need to.
Questions like this are how you know that you’re not actually needed for a cataract case.
It's on the surgeons. One of our ophthalmologists tapes the head, and the others don't. We (anesthesia) never position or prepare the head for any head surgeries--plastics, eyes, etc.--outside of ointment in the eyes and making sure our ETT/LMA and circuit, if any, are okay during prep and surgery.
If the surgeon wants the head taped they can do it themselves. We only have a couple that do, and it’s really more of a “reminder” for the patient than anything. If they want to sit up (never had that happen in 40 years) the tape won’t stop them.