372
THE CASE FOR GENERAL ANESTHESIA*
Swvrus LYNCH, M.D. Director, Department of Anesthesiology Manhattan Eye, Ear, and Throat Hospital
Clinical Associate Professsor of Anesthesiology Cornell University Medical Center New York, N.Y.
URING the past I4 years more than 15,000 patients undergoing operation for cataract at Manhattan Eye, Ear, and Throat Hospital received general anesthesia. Because this practice is at variance with the widely accepted use of local analgesia for intraocular surgery, we felt that an evaluation of the two modalities would be of interest. In all, 2,2 17 consecutive patients receiving general anesthesia for cataract surgery were studied during the two-year computerized investigation, and a comparison was made with 56 similar patients operated on under local analgesia during the same period. RESULTS The average age of a cataract patient is 70 years, and in our series the oldest was aged 98. Cardiovascular disease, such as arteriosclerotic heart disease, previous myocardial infarction, concurrent angina pectoris, borderline congestive failure, or hypertension, was present in 57.5% of patients. The incidence of diabetes was I3.5%; hypothyroidism occurred in 3.5%. Neurological disease: i.e., Parkinsonism or previous cerebral vascular accident, affected 7%, and 6% had some form of chronic pulmonary disease. Listed in Tables I and II are surgical and medical complications of general and local anesthesia in these patients. Vomiting occurred more frequently in the.general anesthesia group (O%), whereas with local anesthesia only 3.5% vomited. The incidence of the full-bladder syndrome (2.8%) was the same for both groups of patients, but only o.9% required catheterization. There were no deaths on the operating table in either group. *Presented at a combined meeting on Anesthesia in Ophthalnology held by the Section on Anesthesiology and Resuscitation of the New York Academy of Medicine and the New York Society for Clinical Ophthalmology at the Academy March 4, 1974.
Bull. N. Y. Acad. Med.
GENERAL ANESTHESIA
373
373
GENERAL
TABLE I. SURGICAL COMPLICATIONS OF OPERATIONS FOR CATARACT
Complication
General anesthesia*
Local anesthesiat
3.5% a.0% 0.4% 8.0% 0.2% 0.09%
3.6% 1.9% 1.0%
Loss of vitreous Shallow chamber Flat chamber Hyphema Dehiscence of wound Prolapse of iris
8.0%0 0.2% 0.17%o
*2,217 consecutive patients studied. t561 consecutive patients studied.
TABLE II. MEDICAL COMPLICATIONS OF OPERATIONS FOR CATARACT
Complication
General anesthesia*
Hepatitis Disorientation Thrombophlebitis Pulmonary embolism Myocardial infarction Pneumonia Cerebral vascular accident Diabetic Coma Atelectasis
0 0.5% 0.1%
0.1%7
0.1%b
0.1% 0 0 0.04%
Local anesthesiat 0. 0.5% 0 0 0 1.3% 0.2% 0.4,o 0.11%
*2,217 Consecutive patients studied. t561 consecutive patients studied.
CONCLUSION
This study tends to show that for the cataract patient general anesthesia, when administered by anesthesiologists who are familiar with the special requirements of cataract surgery, is safe and does not increase the incidence of the surgical complications feared by the ophthalmologist. Despite the advanced age of the average cataract patient, medical complications occur with extraordinary rarity.
Vol. 51, No. 3, March 1975
THE CASE FOR GENERAL ANESTHESIA*
Swvrus LYNCH, M.D. Director, Department of Anesthesiology Manhattan Eye, Ear, and Throat Hospital
Clinical Associate Professsor of Anesthesiology Cornell University Medical Center New York, N.Y.
URING the past I4 years more than 15,000 patients undergoing operation for cataract at Manhattan Eye, Ear, and Throat Hospital received general anesthesia. Because this practice is at variance with the widely accepted use of local analgesia for intraocular surgery, we felt that an evaluation of the two modalities would be of interest. In all, 2,2 17 consecutive patients receiving general anesthesia for cataract surgery were studied during the two-year computerized investigation, and a comparison was made with 56 similar patients operated on under local analgesia during the same period. RESULTS The average age of a cataract patient is 70 years, and in our series the oldest was aged 98. Cardiovascular disease, such as arteriosclerotic heart disease, previous myocardial infarction, concurrent angina pectoris, borderline congestive failure, or hypertension, was present in 57.5% of patients. The incidence of diabetes was I3.5%; hypothyroidism occurred in 3.5%. Neurological disease: i.e., Parkinsonism or previous cerebral vascular accident, affected 7%, and 6% had some form of chronic pulmonary disease. Listed in Tables I and II are surgical and medical complications of general and local anesthesia in these patients. Vomiting occurred more frequently in the.general anesthesia group (O%), whereas with local anesthesia only 3.5% vomited. The incidence of the full-bladder syndrome (2.8%) was the same for both groups of patients, but only o.9% required catheterization. There were no deaths on the operating table in either group. *Presented at a combined meeting on Anesthesia in Ophthalnology held by the Section on Anesthesiology and Resuscitation of the New York Academy of Medicine and the New York Society for Clinical Ophthalmology at the Academy March 4, 1974.
Bull. N. Y. Acad. Med.
GENERAL ANESTHESIA
373
373
GENERAL
TABLE I. SURGICAL COMPLICATIONS OF OPERATIONS FOR CATARACT
Complication
General anesthesia*
Local anesthesiat
3.5% a.0% 0.4% 8.0% 0.2% 0.09%
3.6% 1.9% 1.0%
Loss of vitreous Shallow chamber Flat chamber Hyphema Dehiscence of wound Prolapse of iris
8.0%0 0.2% 0.17%o
*2,217 consecutive patients studied. t561 consecutive patients studied.
TABLE II. MEDICAL COMPLICATIONS OF OPERATIONS FOR CATARACT
Complication
General anesthesia*
Hepatitis Disorientation Thrombophlebitis Pulmonary embolism Myocardial infarction Pneumonia Cerebral vascular accident Diabetic Coma Atelectasis
0 0.5% 0.1%
0.1%7
0.1%b
0.1% 0 0 0.04%
Local anesthesiat 0. 0.5% 0 0 0 1.3% 0.2% 0.4,o 0.11%
*2,217 Consecutive patients studied. t561 consecutive patients studied.
CONCLUSION
This study tends to show that for the cataract patient general anesthesia, when administered by anesthesiologists who are familiar with the special requirements of cataract surgery, is safe and does not increase the incidence of the surgical complications feared by the ophthalmologist. Despite the advanced age of the average cataract patient, medical complications occur with extraordinary rarity.
Vol. 51, No. 3, March 1975
