CATARACT EWAP MARCH 2024 13 second eye, setting expectations beforehand, giving patients plenty of verbal anesthesia during the case, and working with the anesthesia team for the appropriate medications. “They’re always going to have some level of anxiety and sometimes agitation about the experience being different, so I think preparation is most important,” he said. EWAP Editors’ note: Dr. Braga-Mele is Professor of Ophthalmology, University of Toronto, Toronto, Canada. Dr. Lin is Assistant Professor of Cataract and Refractive Surgery, Associate Residency Program Director, and Medical Director, UCLA Stein Eye Center Calabasas, Los Angles, California. Neither declared any relevant financial interests. A s a team of cataract doctors in the ophthalmology department of a general hospital, we often have to face the agitation in the operating room from patients whose conditions fluctuate during the cataract surgeries. Usually, the anticipated agitation in the O.R. brings less worry. An unexpected agitation may make the surgical procedure difficult, terminate the surgery, even endanger the safety of patients. Fortunately, an unexpected agitation can be transformed into anticipated agitation by prior evaluation, adequate preparation, timely and accurate reaction to minimize possible harm. Common agitations in O.R. from patients include: 1. Psychological conditions: such as claustrophobia, fainting during acupuncture or with sight of bleeding, manic episodes, anxiety and stress causing breathlessness or hyperventilation, sudden increases in blood pressure or heart rates, and so on. 2. Systemic conditions: sudden increases in blood pressure, heart rates, blood glucose, body temperature; physical dysfunction such as kyphosis or spinal disorders; significant head or eyeball tremors. For psychological or systemic conditions, it is most important to ask for medical history in detail and seek for specialist help before surgery. An adequate education can relieve the patient’s anxiety. An enough sleep, reasonable diet and suitable clothing can reduce the fluctuation of heart rate, body temperature, blood pressure and glucose. All vital signs should be checked before patients transferring into O.R. For a high-risk patient, it is better to select a skilled surgeon, a surgical approach with less damage and shorter duration, and determine an appropriated anesthesia by the surgeon, anesthesiologist and patient together. For a local anesthesia patient, sedatives and oxygen can be used. Physical dysfunctional patient can be well equipped with protective gear and cushions. If the local anesthesia cannot help the surgery being completed safely, preparation in advance and timely switch for general anesthesia can help to complete the operation successfully. The better choice is to postpone the operation and control the patient’s condition when the patient is complicated with acute infection or other severe general condition that endangers the patient’s safety. 3. Eye conditions: including sudden aggravation in the previous condition, such as significant extension of lens dislocation at the supine position compared with sitting examination, sudden increase of intraocular pressure after mydriasis in a narrow-angle eye; occurrence of new signs, such as ocular bleeding, corneal opacity, new fundus lesions. It is very important to do: full ophthalmic examinations before surgery with mydriasis if permitted and/or with supine position if lens/IOL dislocated happened; systemic examinations including blood coagulation function and platelet counting; peri-operative medication such as IOPlowering drugs, NSAIDS, hemostatic drugs, antibiotics; a preoperative conversation containing of all possibility; recheck of important examination before a complicated cataract surgery such as slit-lamp, fundus examination, IOP, B-scan, UBM or AS-OCT if necessary; the selection of suitable anesthetics, mydriatics and antiseptics; full preparations of possible equipments, supplies and instruments; professional personnel supporting such as a retinal or corneal surgeon; a green channel for possible patient transport. Editors’ note: Dr. Xu disclosed no relevant financial interests. Wen Xu, MD Eye Center, 2nd Affiliated Hospital of Zhejiang University 88 Jiefang Road, Hangzhou, China xuwen2003@zju.edu.cn ASIA-PACIFIC PERSPECTIVES
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