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Online ISSN 1827-1596
Basta B. 1, Gioia L. 1, Gemma M. 1, Dedola E. 1, Bianchi I. 2, Fasce F. 2, Beretta L. 1
1 Department of Anesthesiology and Intensive Care, San Raffaele Scientific Institute, Milan, Italy;
2 Department of Ophthalmology and Visual Sciences, San Raffaele Scientific Institute, Milan, Italy
BACKGROUND:The aim of the study was to evaluate the systemic adverse events triggering on-call anesthesiologist’s intervention during 2005 phacoemulsification under topical anesthesia on a day-surgery monitored anesthesia care regimen.
METHODS: Adverse events triggering an anesthesiologist call by the attending nurse were registered. Comorbidities (7 categories), age, gender, body mass index, ASA status, length of surgery, time of the day of surgery and operated eye (first/second) were analyzed as potentially predictive factors. Odds Ratios are expressed as OR (95% CI).
RESULTS:The anesthesiologist was called in 433 (21.6%) cases: age (5-yr-OR 0.95 [0.91-0.99]), ASA status 3-4 (OR 1.37 [1.02-1.85]), positive neurological history (OR 1.60 [1.06-2.40]), positive psychiatric history (OR 2.56 [1.34-4.93]) and length of surgery (OR 1.03 [1.01-1.06]) were predictive of the anesthesiologist call. Arterial hypertension (10.3%) and agitation (9.5%) were the most frequent adverse events. Age (5-yr-OR 1.27 [1.16-1.38]) and ASA status 3-4 (OR 1.83 [1.30-2.56]) were predictive of arterial hypertension. Age (5-yr-OR 0.80 [0.76-0.85]), positive neurological history (OR 1.86 [1.10-3.14]) and positive psychiatric history (OR 4.48 [2.26-8.88]) were predictive of agitation. Interruption of surgery was never required.
CONCLUSION: One-day cataract surgery performed under topical anesthesia with monitored anesthesia care required anesthesiologist intervention in 21.6% of cases, mainly because of agitation or hypertension. Agitation occurred more often in younger patients with neurological or psychiatric comorbidities. Hypertension occurred more often in older patients with higher ASA scores.