Oral Sedation for Cataract Surgery

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Although intravenous sedation quells the perioperative anxiety of cataract surgery patients, its use requires preoperative fasting, placement of an IV line, and costly monitoring by an anesthesia provider in an operating room setting. Could patients instead be calmed effectively with oral sedation, which is more convenient and less costly?

A study by a team of Boston University ophthalmol­ogists found similar levels of satisfaction with both IV and oral sedation among patients undergoing cataract surgery—and the same was true for the surgeons who performed the procedures.¹

Study specifics. For this prospective masked study, 85 patients were randomized to either oral triazolam (n = 42) or IV midazolam (n = 43). All participants—the patients, their surgeons (n = 11), and anesthesiology staff—completed surveys on postoperative day 1 re­garding their satisfaction level with the two approaches to sedation.

On a scale of 1 to 6 (with 6 being the highest score), patients’ mean satisfaction score was 5.34 ± 0.63 (range, 3.75-6) for those who had received oral sedation and 5.40 ± 0.52 (range, 4-6) for those who received IV sedation (p value for noninferiority = 0.0004).

For surgeons, the mean satisfaction score was 5.11 ± 1.11 (range, 2.83-6) for oral sedation and 5.45 ± 0.78 (range, 3.4-6) for IV sedation. For anesthesia providers, those scores were 4.97 ± 1.10 (range, 2.17-6) for oral sedation and 5.35 ± 0.78 (range, 3-6) for IV sedation.

Complications. The only major intraoperative com­plication, a posterior capsular tear, was in the IV group. Eleven patients (12.9%), eight of whom were in the oral group, required supplemental IV anesthesia or sedation for intraoperative anxiety or discomfort.

Next steps. The researchers are extending their study to a cohort of nearly 400 patients, and they will try to determine risk factors associated with “anxious outliers” who are unsuitable for oral-only sedation, said coau­thor Crandall E. Peeler, MD, at Boston Medical Center.

“Where we work, in a busy urban, academic med­ical center, there’s a lot of demand for outpatient OR space,” Dr. Peeler said. “If we can show that patients are comfortable with oral sedation for cataract surgery, then maybe we could move some low-risk surgeries from an OR setting to a procedure room, thereby improving efficiency and convenience for our patients and potentially saving money for the health care sys­tem in general.”

—Linda Roach

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1 Peeler CE et al. Ophthalmology. Published online April 16, 2019.

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Relevant financial disclosures—Dr. Peeler: None.

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