19. Cataract Flashcards
A 76-year-old man is scheduled for elective cataract surgery under local anaesthesia.
a) Summarise the goals of local anaesthesia (LA)
for this procedure. (15%)
> > To provide pain-free surgery.
> > To facilitate the surgical procedure.
> > To minimise the risk of systemic +local complications
> > To reduce the risk of surgical complications.
b) Which LA techniques may be used for cataract surgery? (20%)
> > Topical.
> > Subconjunctival.
> > Sub-Tenon’s.
> > Peribulbar (extraconal).
> > Retrobulbar (intraconal).
c) List the contraindications to the use of LA as the sole technique for the procedure. (25%)
> > Patient refusal.
> > Allergy to LA.
> > Localised sepsis.*
> > Inability to cooperate due to anxiety,
confusion, learning difficulties.
> > Inability to lie flat and still
due to musculoskeletal,
respiratory or cardiac
conditions, or significant cough.
> > Inability to tolerate ocular manipulation
without blepharospasm.*
> > Grossly abnormal coagulation
d) Which details specific to an LA block should be documented in the anaesthetic record? (40%)
The name, job role and IMC number of the person performing the block.
The exact technique employed, including the following:
> > Asepsis.
> > Entry site/s.
> > Length and type of needle/cannula.
> > Volume and concentration of LA agent and adjuvant.
> > Requirement for supplemental LA.
> > Use of oculo-compression.
> > Use of systemic analgesia or sedation.
> > Quality of block.
> > Complications.
Monitoring techniques,
frequency and recordings should be noted.
Details of any complications,
discussions, interventions or advice offered.
