Adverse intraoperative medical events and their association with anesthesia management strategies in cataract surgery

Objective. To compare adverse medical events by different anesthesia strate gies for cataract surgery. Design: Prospective cohort study. Participants: Patients 50 years of age and older undergoing 19,250 cataract surgeries at nine centers in the United States and Canada between June 199 5 and June 1997. Intervention: Local anesthesia applied topically or by injection, with or w ithout oral and intravenous sedatives, opioid analgesia, hypnotics, and dip henhydramine (Benadryl). Main Outcome Measures: Intraoperative and postoperative adverse medical eve nts. Results: Twenty-six percent of surgeries were performed with topical anesth esia and the remainder with injection anesthesia. There was no increase in deaths and hospitalizations associated with any specific anesthesia strateg y. No statistically significant difference was observed in the prevalence o f intraoperative events between topical and injection anesthesia without in travenous sedatives (0.13% and 0.78%, respectively). The use of intravenous sedatives was associated with a significant increase in adverse events for topical (1.20%) and injection anesthesia (1.18%), relative to topical anes thesia without intravenous sedation. The use of short-acting hypnotic agent s with injection anesthesia was also associated with a significant increase in adverse events when used alone (1.40%) or in combination with opiates ( 1.75%), sedatives (2.65%), and with the combination of opiates and sedative s (4.04%). These differences remained after adjusting for age, gender, dura tion of surgery, and American Society of Anesthesiologists risk class. Conclusions. Adjuvant intravenous anesthetic agents used to decrease pain a nd alleviate anxiety are associated with increases in medical events. Howev er, cataract surgery is a safe procedure with a low absolute risk of medica l complications with either topical or injection anesthesia. Clinicians sho uld weigh the risks and benefits of their use for individual patients. Opht halmology 2001;108:1721-1726 (C) 2001 by the American Academy of Ophthalmol ogy.