CATARACT EWAP MARCH 2024 11 A nxiety is common among patients headed into the OR for cataract surgery, but when anxiety turns into agitation, it could mean a higher risk for intraoperative complications or a delay in surgery. “At least 10% [of patients] can become anxious or agitated. This can take many forms, from a patient shaking their leg to something more drastic such as suddenly moving their head,” said Shawn Lin, MD. Rosa Braga-Mele, MD, further differentiated. She also said she thinks anxiety occurs in 10 – 20% of cases, while 5% of patients experience some disinhibition and 1% reach true agitation. “It’s a spectrum,” Dr. Braga-Mele said. “Agitation itself is very rare. It’s a whole spectrum of anxiety, disinhibition, agitation.” The anxiety spectrum Anxiety is normal and experienced to some level by all patients who are fearful of the operation. Dr. Braga-Mele said Contact information Braga-Mele: rbragamele@rogers.com Lin: slin@jsei.ucla.edu Agitation in the OR by Liz Hillman Editorial Co - Director anxiousness can be controlled with more medications or verbal anesthesia (talking to the patient before and during the surgery about what to expect and what’s going on). Disinhibition is when the person is not entirely in control of their faculties, she continued, and can occur with too much medication, due to patient personalities or pre-existing conditions, or how they react to medication. Working with anesthesia, handholding, and gentle verbal anesthesia is helpful in these situations. Agitation occurs when the patient is out of control to a point where surgery needs to stop temporarily or be postponed entirely for patient safety. When a patient becomes truly agitated, Dr. Lin said it’s often too late for anesthesia to make efficient adjustments for the case. “The key is to recognize it early enough to come out of the eye before the real agitation occurs,” Dr. Braga-Mele said. “Deal with the agitation, talk to the patient before you go back into the eye. Don’t try to deal with agitation while you’re in the middle of doing phaco because they may move.” Preventative medicine Dr. Lin said he thinks the most important thing to alleviate anxiety and help avoid true Dr. Lin talks to a patient while administering proparacaine before cataract surgery. He likes to speak with patients outside the room to try to make them comfortable. Source: Shawn Lin, MD This article originally appeared in the December 2023 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.
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