general anesthesia for cataract surgery?

The doc I saw yesterday said he planned to put me under for the
cataract surgery. He said I was nervous.

I am nervous, and I know it's a complex cataract, so will take more
than just a few minutes, but ... is this a good idea? I thought there
were other kinds of drugs that left you still conscious but too doped
up to be nervous.
(I've never been under any of them, as the only surgeries I've had
were root canals. Those docs offered me laughing gas, but that meant
having a gas mask over my face the whole time, which was an even
bigger stress to me than the surgery, so we abandoned that and used
local.)

What is normally done and why?

thanks,
Liz

 

I don't know what is normally done in the US. My HMO generally tries
not to knock people out for surgery.

In addition to the two cataract surgeries (both routine), I have had a
hernia repair (major abdominal surgery) and a cataract repair (minor,
but two full hours), all while awake. I had a another cataract repair
when out of state, so my HMO didn't do it. It was 2 1/2 hours and the
doctor suggested that I wouldn't want to be awake for it. I took his
word for it, although my second cataract surgery was no problem,
although I was completely awake for it.

I have posted about this before, so you can try to look those up, if
you'd like. Based on my experiences, I prefer being awake, as long as
there is sufficient tranquilizer (I don't deal well with blood, pain or
knives).

 

Wow. My hat is off to you - I just cannot imagine not being able to
move my eyes for a minute let alone hours.

David - who will go for full asleep when getting eye surgery

 

Fortunately, I don't remember any details, but I don't think that you
have any voluntary eye control on the operated eye. At least one time,
I remember them putting a metal clip on the eye to keep it open.

There's an IV in you the whole time. Once I didn't get enough drugs,
and was quite unhappy (and switched surgeons), but the other times, I
had enough "happy juice" that I didn't care what they did. The drugs
seemed short acting though. I believe I was released from the hospital
one half hour after my last (two hour) surgery.

 

I had cataract surgery with topical anesthesia (eye drops). I could
feel pressure, but it was not painful. If you are very nervous, light
IV sedation might be an option. General anesthesia might be
appropriate for a demented or uncooperative patient, which don't apply
in your case. If the surgeon insists on general anesthesia, then
consult someone else.

 

Dear Liz,

Subject: "Complex" Cataract?

Could you explain?

My own experience was that I was obviously "nervous" aboutt this
issue. Who would'nt be?

I am certain they gave me smoething to "calm" me down.

The actual "operation" took about 15 to 20 minutes.

You have a very bright light in your eye -- that is annoying.

There is some discomfort -- for a period of time.

I don't know what is "normal" here. The "old" method probably
requires extensive anathesia. If that is the case -- I would find a
more "modern" cataract surgeon.

Again, no one can give you advice here, I can only state my
experience.

If I were you, I would search for friends who have had this surgery,
and find out what they went through. That is how I "found" the
ophthalmologist to do my surgery.

Best,

Otis

 

The norm for cataract surgery here in Chicago is topical anesthesia
(eye drops) with or without light IV sedation. Most surgeons want
their patient to be alert enough to be able to follow instructions.
I'd suggest that you avoid the use of injectable anesthesia, which
raises the risk level. General anesthesia definitely carries the most
risk, and I don't see how this additional risk would be justified in
your case.

 

General anesthesia might be

Sez YOU. The thought of some bloke who might or might not have had a
fight with his missus or be having a bad day poking at my eyes with a
scalpel is enough to make me well and truly demented!

If the surgeon insists on general anesthesia,

Bugger what he wants, he's getting paid to do what I want, and it is
what I want that is important

David

 

If you wanted to assume the risks of general anesthesia for cataract
surgery, I'm sure that just about all surgeons would go along with
your preference.

 

Usually cataract is done with local, but a general will be used if
there is compelling reason. Surgeons do not take general anesthesia
lightly and I expect your surgeon would not recommend it without a
compelling reason.

I have had a few patients have cataract under general. One was a
woman who faints easily and often; it would be a disaster if she
fainted on the table. Others had complex surgeries or were, due to
various factors, likely to be unable to co operate during surgery.

This is not an issue to be resolved by talking to strangers on the
Internet who are not surgeons and do not know the particulars of your
case. If concerned, discuss this further with your surgeon and the
doctor who will be administering the anesthesia. You could also
request a second opinion about the need for a general. Doctors
usually want you to be fully informed and will gladly recommend
someone for a second opinion.

Judy

 

I agree with you completely, Dr. Judy, but I personally found it very
helpful to talk to as many patients and non-surgeons as possible, before
resolving issues like this with the surgeon. I don't think the surgeon
has any choice but to make decisions for the patient if said patient is
not knowledgeable and confident about what they want.

My first cataract surgery went very well, and I was happy that I was
awake for it, since very little recovery was necessary. The patient
after me had general anesthesia. He had had his pre-op appointment
right before me, the day before. I could hear it, as the exam room was
right across the hall from the waiting room, and the doctor was yelling
as loudly as he could. The patient was deaf and uncooperative. The
patient's wife refused to help communicate. The doctor was unwilling to
perform eye surgery on someone who was awake and didn't know what was
going on.

 

I've had eye surgery (including two retinal procedures) five times in
the past few years. Maybe my experience is not typical, but (with one
exception) the surgeon was not concerned about the type of anesthesia
used. One surgeon told me that his job would be the same regardless
of the anesthesia used. I suppose that they all assumed (correctly)
that I would be cooperative during the surgery. My last retinal
surgery was done with only local anesthesia at the surgeon's request,
and this was fine with me since it was my preference, too. After one
experience with IV sedation, I'd opt for local (or better yet,
topical) anesthesia given the choice. None of my eye surgeries was
painful

 

Dan, a cataract REPAIR? Qu'est-ce que c'est?

Yikes, four surgeries. I'm lucky to have only had root canals.

I did. You wrote, "The general has significant risk."


What kind of risk?

OK.


The doctor mentioned me being put to sleep right off the bat, long
before I asked any questions that would have indicated unusual
nervousness. He does a lot of difficult corneal work; is in a group
of about 20 eye docs who do only specialty surgery, which occurs in
the same building dedicated to their practice.
I wonder if most of the work they do requires general anesthesia;
perhaps this is their normal default. Maybe that explains why he
suggested this.


Liz D.
Indy

 

"Complex" Cataract? Could you explain?


It's white. The opacity makes it harder to operate on, so they call
it "complex".

Among other things, they put blue dye in your eye so they can clearly
see where they're cutting, and they are (I hope!) more careful when
removing the lens, which sometimes has become more solid or more
liquid than a lens normally is.


He also said he allows 45 minutes for surgery, to avoid rushing. I
don't know how long a "complex cataract" usually takes - anyone?


Liz
Indy

 

The norm for cataract surgery here in Chicago

Chicago!! I used to live there. *sigh*

Instructions? They tell you what to do during surgery?
What happens if the patient is too drugged, or whatever, to follow
instructions?

What exactly ARE the risks? Does the drug does something undesirable
to your eye? Or is it a risk to the rest of you?
(You can see I know nothing whatsoever about these drugs; the only
anesthetic I've ever experienced was novocaine with a dentist.)


thanks Jane....
Liz
Indy

 

there is compelling reason.  Surgeons do not take general anesthesia

Heavens, no.
!
But before I go back and talk to the doc (or to another doc for a
second opinion), I like to get an idea of what questions to ask.
Usually, internet discussions, carefully vetted, can provide enough
clues to enable me to know what to ask about. This list, because of
the handful of remaining pros, is especially helpful - I at least hear
about some of the issues in advance of visiting him, and so can
collect my thoughts.

thanks,
Liz
Indy

 

Sorry, I guess I had "cataract" on the brain and in the fingers. It was
a retinal detachment repair. My first eye surgery was for a retinal
detachment in the right eye. I had cataract in that eye for a few years
before then, but not bad enough that my doctor would fix it. Then I had
the cataract surgery in that eye. Five years later, cataract surgery in
the left eye. A few years later, I had a retinal detachment in the left
eye. I hope I'm done with eye surgery!

From my HMO web site:

"Most cataract surgery is now done using a topical anesthetic (eyedrops)
or a local anesthetic. Local anesthetic may involve a sedative for
relaxation followed by an injection beside, under, or inside the eye to
deaden nerves and prevent blinking or eye movement during surgery.

General anesthetic may be necessary for:

* People with extreme anxiety that cannot be controlled with simple
sedation or counseling.
* People who are unable to follow instructions during surgery.
* People who are allergic to certain local anesthetics.
* People with other medical conditions that require the use of a
general anesthetic.
* Children."

Also from my HMO web site:

"Death occurs in about 1 in 250,000 people receiving general anesthesia,"

I would suggest that you check it out yourself if you are interested.
It should be the same irrespective of what is being done to you. My
information, which I have forgotten, was minimal and may well be
outdated. I know that when it comes to surgery, my HMO likes to do as
little as possible. This not only saves them money, but they claim it
is healthier for their patients.

I don't have much of a clue. I wish you luck in your negotiations.
I'll note (maybe again) that my last eye surgery was two hours, and was
the repair of a retinal detachment, so it was surgery to the back of the
eye. I remember listening to the two doctors talking, although I didn't
care the least what they were saying.

 

My mom was claustrophobic -- even putting a cloth over her face sent her into a
panic attack. Knocking her out was the only option. No particular bad result,
except the quack gave her near vision instead of distant vision, which is what
she would have chosen had she been asked :-(

Last time I had it they had to use a double dose (unknown chemical) to put me
under. I was out far longer than usual, and I spent the next two days
nauseated and vomiting. I ultimately went to the ER, where they filled me up
with electrolytes and sent me on my way.

I got better.

I normally cry and throw up when I wake up (3 previous times), but this was
excessive!

 

FWIW, the ER doc said that "general anaesthesia" also involves breathing
equipment. "Conscious sedation" is what usually happens for minor surgery,
and apparently they can get you to wake up if they yell at you really loudly.

 

Nausea and vomiting are not uncommon side effects of general
anesthesia. Death and permanent cognitive impairment are rare but
possible side effects.