Assessing the quality of ophthalmic anesthesia

The study objective is to evaluate a scoring system to assess the quality of anesthesia used in ophthalmic surgery.This is an observational prospective study.The setting is at an operating theater.Patients are all patients undergoing ophthalmic surgery, October 2012.Quality of ophthalmic anesthesia was measured using an interval scale by the operating surgeon. Parameters were graded depending on the type and route of anesthetic: central eye position, anesthesia, akinesia of the eye and or body, soft tissue or orbital hemorrhage, and absence of vitreous bulge.The measurements are quality score and proportion of optimal and suboptimal cases of anesthesia and number of surgical complications.Data were collected on 349 consecutive cases including cataract (55%), retinal (14%), corneal transplant (6%), and strabismus surgery (6%). Sub-Tenon was the most commonly performed (31%) followed by peribulbar (PB) (26%), general anesthesia (GA) (20%), topical (17%), and retrobulbar (RB) (6%) anesthesia. There were 11 surgical complications: posterior capsule rupture (7), dislocated lens (2), and orbital hemorrhage (2). Sub-Tenon had lower quality scores than PB (P = .006), RB (P = .028), and GA (P.001); and PB and RB had lower scores than GA (P.01). There was a significant association between suboptimal anesthesia and surgical complications (P.001), odds ratio = 3.94 (95% confidence interval, 1.03-15.12; P = .046).The quality of ophthalmic anesthesia is an important component of the surgical procedure and should be considered in any risk stratification. Suboptimal anesthesia is associated with an increased rate of surgical complications.