Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942008000100004
Brazilian Journal of Anesthesiology
Scientific Article

Anestesia tópica associada à sedação para facoemulsificação: experiência com 312 pacientes

Topical anesthesia associated with sedation for phacoemulsification: experience with 312 patients

Romero Henrique Carvalho Bertrand; João Batista Santos Garcia; Caio Márcio Barros de Oliveira; Adriana Leite Xavier Bertrand

http://dx.doi.org/10.1590/S0034-70942008000100004 Braz J Anesthesiol, vol.58, n1, p.23-34, 2008
PDF Português
PDF English
Downloads: 1
Views: 1329

Resumo

JUSTIFICATIVA E OBJETIVOS: A anestesia tópica vem ganhando espaço nas operações de catarata, sobretudo após os avanços advindos com a técnica de facoemulsificação. O objetivo desse estudo foi avaliar a eficácia da anestesia tópica associada à sedação para operações de catarata por facoemulsificação. MÉTODO: Estudo prospectivo de 312 pacientes, ASA I e II, com idades entre 41 e 89 anos. Foi realizada a facoemulsificação sob anestesia tópica (cinco minutos antes da operação, por gotejamento com proximetacaína a 0,5%) associada à sedação (midazolam, 1 mg, por via venosa, administrado 15 minutos antes da operação). Alfentanil em bolus de 125 µg por via venosa foi administrado sob demanda. Variáveis como dor no intra-operatório, consumo de alfentanil, efeitos colaterais, tempo de recupe\ração e nível de satisfação do paciente foram analisados. RESULTADOS: No período intra-operatório foram observados oito (2,6%) casos de bradicardia, quatro (1,3%) de edema epitelial, dois (0,65%) de náuseas e duas (0,65%) rupturas de cápsula posterior. No pós-operatório foram observados 15 (4,8%) casos de náuseas, seis (1,9%) casos de tonturas, dois (0,65%) casos de vômitos e um (0,32%) caso de bradicardia. O tempo médio de recuperação pós-operatória foi de 21,77 minutos. O consumo de alfentanil variou entre 125 µg e 1.250 µg, com um consumo médio de 537 µg. Trezentos (96,2%) pacientes classificaram a técnica anestésica como boa e 12 (3,8%) pacientes classificaram como regular. Quarenta e dois pacientes relataram dor em algum momento da operação e quatro (1,3%) pacientes disseram que caso necessitassem realizar um novo procedimento de facoemulsificação não gostariam de ser submetidos à mesma técnica anestésica. CONCLUSÕES: A anestesia tópica com sedação em pacientes submetidos a operações de catarata por facoemulsificação, neste estudo, demonstrou eficácia, fácil aplicação e complicações mínimas.

Palavras-chave

ANESTESIA, Local, CIRURGIA, Oftálmica, CIRURGIA, Oftálmica, SEDAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: The use of topical anesthesia in cataract surgeries has been increasing, especially after the development of phacoemulsification. The objective of this study was to evaluate the efficacy of topical anesthesia associated with sedation for cataract extraction by phacoemulsification. METHODS: A prospective study was conducted with 312 patients, ASA I and II, ages 41 to 89 years. Phacoemulsification was performed under topical anesthesia (5 minutes before surgery, by dripping 0.5% proximetacaine) associated with sedation (intravenous midazolam, 1 mg, administered 15 minutes before the surgery). Intravenous bolus of alfentanil, 125 µg, were administered under demand. Parameters, such as intraoperative pain, consumption of alfentanil, side effects, recovery time, and level of patient satisfaction were analyzed. RESULTS: In the intraoperative period, 8 (2.6%) cases of bradycardia, 4 (1.3%) of epithelial edema, 2 (0.65%) of nausea, and 2 (0.65%) ruptures of the posterior capsule were observed. In the postoperative period, 15 (4.8%) cases of nausea, 6 (1.9%) cases of dizziness, 2 (0.65%) of vomiting, and 1 (0.32%) case of bradycardia were observed. The mean time of postoperative recovery was 21.77 minutes. Consumption of alfentanil varied from 125 µg to 1250 µg, with a mean consumption of 537 µg. Tree hundred (96.2%) patients classified the technique as good and 12 (3.8%), as regular. Forty-two patients complained of pain sometime during surgery, and 4 (1.3%) patients said that if they needed another phacoemulsification, they would not like to undergo the same anesthetic technique. CONCLUSIONS: In this study, topical anesthesia with sedation of patients undergoing cataract removal by phacoemulsification demonstrated to be effective, easy to apply, and had a very low incidence of complications.

Keywords

ANESTHESIA, Local, SEDATION, SURGERY, Ophthalmologic, SURGERY, Ophthalmologic

References

Bernardes F. Facectomias. Catarata. 2003:137-148.

Knapp H. On cocaine and its use in ophthalmic self-sealing surgery. Arch Ophthalmol. 1984;13:402-448.

Dinsmore SC. Drop, then decide approach to topical anesthesia. J Cataract Refract Surg. 1995;21:666-671.

Kallio H, Uusitalo RJ, Maunuksela EL. Topical anesthesia with or without propofol sedation versus retrobulbar/peribulbar anesthesia for cataract extraction: prospective randomized trial. J Cataract Refract Surg. 2001;27:1372-1379.

Fichman RA. Use of topical anesthesia alone in cataract surgery. J Cataract Refract Surg. 1996;22:612-614.

Kershner RM. Topical anesthesia for small incision self-sealing surgery: a prospective evaluation of the first 100 patients. J Cataract Refract Surg. 1993;19:290-292.

Zafirakis P, Voudouri A, Rowe S. Topical versus sub-Tenon's anesthesia without sedation in cataract surgery. J Cataract Refract Surg. 2001;27:873-879.

Katz J, Feldman MA, Bass EB. Injectable versus topical anesthesia for cataract surgery: patient perceptions of pain and side effects: The Study of Medical Testing for Cataract Surgery study team. Ophthalmology. 2000;107:2054-2060.

Bernardes F, Dias FR. Anestesia Tópica em Cirurgia de Catarata. Cirurgia da Catarata: Rio de Janeiro. 2000:49-52.

Javitt JC, Wang F, West SK. Blindness due to cataract: epidemiology and prevention. Annu Rev Public Health. 1996;17:159-177.

Kara-José N, Temporini ER. Cirurgia de catarata: o porquê dos excluídos. Rev Panam Salud Pública. 1999;6:242-248.

Myasi A. Avaliação Sistêmica. Cristalino e Catarata: Diagnóstico e Tratamento. 2004:15-19.

Wagner T, Knaflic D, Rauber M. Influence of cataract surgery on the diabetic eye: a prospective study. Ger J Ophthalmol. 1999;5:79-83.

Gabow HB. - Topical anesthesia for cataract surgery. Eur J Implant Refract Surg. 1993;5:20-24.

Soliman MM, Macky TA, Samir MK. Comparative clinical trial of topical anesthetic agents in cataract surgery: lidocaine 2% gel, bupivacaine 0.5% drops, and benoxinate 0.4% drops. J Cataract Refract Surg. 2004;30:1716-1720.

Mathew MR, Webb LA, Hill R. - Surgeon experience and patient comfort during clear corneal phacoemulsification under topical local anesthesia. J Cataract Refract Surg. 2002;28:1977-1981.

Novak KD, Koch DD. Topical anesthesia for phacoemulsification: initial 20-case series with one month follow-up. J Cataract Refract Surg. 1995;21:672-675.

Coelho RP, Weissheime J, Romão E. Comparação entre a dor provocada pela facoemulsificação com anestesia tópica e pela infiltração peribulbar sem sedação. Arq Bras Oftalmol. 2005;68:45-48.

Chuang LH, Lai CC, Ku WC. Efficacy and safety of phacoemulsification with intraocular lens implantation under topical anesthesia. Chang Gung Med J. 2004;27:609-613.

Arshinoff SA. Dispersive-cohesive viscoelastic soft shell technique. J Cataract Refract Surg. 1999;25:167-173.

Carvalho MJ. Complicações. Cristalino e Catarata: Diagnóstico e Tratamento. 2004:207-224.

Morgan CM, Schatz H, Vine AK. Ocular complications associated with retrobulbar injections. Ophthalmology. 1988;95:660-665.

Gillow JT, Scotcher SM, Deutsch J. Efficacy of supplementary intracameral lidocaína in routine phacoemulsification under topical anesthesia. Ophthalmology. 1999;106:2173-2177.

Kimble JA, Morris RE, Witherspoon CD. Globe perforation from peribulbar injection. Arch Ophthalmol. 1987;105:749.

Duker JS, Belmont JB, Benson WE. Inadvertent globe perforation during retrobulbar and peribulbar anesthesia: Patient characteristics, surgical management, and visual outcome. Ophthalmology. 1991;98:519-526.

Hay A, Flynn HW Jr, Hoffman JI. Needle penetration of the globe during retrobulbar and peribulbar injections. Ophthalmology. 1991;98:1017-1024.

Nielsen PJ. Immediate visual capability after cataract surgery: topical versus retrobulbar anesthesia. J Cataract Refract Surg. 1995;21:302-304.

Davis DB, Mandel MR. Anesthesia for cataract extraction. Int Ophthalmol Clin. 1994;34:13-30.

Germano JE, Giafferis K, Iutaka NT. Rev Bras OftalmolTransição peribulbar-tópica. 2001;60:195-197.

Padilha MA. Facoemulsificação em Núcleos Moles. Catarata. 2003:175.

Habib NE, Mandour NM, Balmer HG. Effect of midazolam on anxiety level and pain perception in cataract surgery with topical anesthesia. J Cataract Refract Surg. 2004;30:437-443.

Griffis CA. Monitored anesthetic care for outpatient cataract surgery with alfentanil. Nurse Anesth. 1990;1:71-78.

Yee JB, Burns TA, Mann JM. Propofol and alfentanil for sedation during placement of retrobulbar block for cataract surgery. J Clin Anesth. 1996;8:623-626.

Hamilton R, Claoué C. Topical anesthesia: Proxymetacaine versus amethocaine for clear corneal phacoemulsification. J Cataract Refract Surg. 1998;24:1382-1384.

Zehetmayer M, Raday U, Skorpik C. Topical versus peribulbar anesthesia in clear corneal cataract sugery. J Cataract Refract Surg. 1996;22:480-484.

Shafi T, Koay P. Randomized prospective masked study comparing patient comfort following instillation of topical proxymetacaine and amethocaine. Br J Ophthalmol. 1998;82:1285-1287.

Patel BC, Clinch TE, Burns TA. Prospective evaluation of topical versus retrobulbar anesthesia: a converting surgeon's experience. J Cataract Refract Surg. 1998;24:853-860.

Fukasaku H, Marron JA. Sub-Tenon pinpoint anaesthesia. J Cataract Refract Surg. 1994;20:673.

Judge AJ, Najafi K, Lee DA. Corneal endothelial toxicity of topical anesthesia. Ophthalmology. 1997;104:1373-1379.

Jolliffe DM, Abdel-Khalek MN, Norton AC. A comparison of topical anaesthesia and retrobulbar block for cataract surgery. Eye. 1997;11:858-862.

Revill SI, Robinson JO, Rosen M. The reliability of linear analogue scale for evaluating pain. Anaesthesia. 1976;31:1191-1198.

Melzack R. Psychological Aspects of Pain: Implications for Neural Blockage. Neural Blockade in Clinical Anesthesia and Management of Pain. 1998:781-792.

Fraser SG, Siriwadena D, Jamieson H. Indicators of patient suitability for topical anesthesia. J Cataract Refract Surg. 1997;23:781-783.

Nosé W. Anestesia tópica para cirurgia de catarata. Universo Visual. 2004;18:18-20.

Cepeda MS, Carr DB. Women experience more pain and require more morphine than men to achieve a similar degree of analgesia. Anesth Analg. 2003;97:1464-1468.

Joels CS, Mostafa G, Matthews BD. Factors affecting intravenous analgesic requirements after colectomy. J Am Coll Surg. 2003;197:780-785.

Reves JG, Fragen RJ, Vinik HR. Midazolam: pharmacology and uses. Anesthesiology. 1985;62:310-324.

Wong DH, Merrick PM. Intravenous sedation prior to peribulbar anaesthesia for cataract surgery in elderly patients. Can J Anaesth. 1996;43:1115-1120.

5dd6cf220e8825cb6213f286 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections