Current Trends in Vitreoretinal Anesthesia

In assessing trends of vitreoretinal (VR) anesthesia, the use of MAC is the most common method for vitreoretinal procedures, according to a study presented by Jayanth Sridhar, MD, Bascom Palmer Eye Institute at the 37^th Annual ASRS Meeting.

Safe, efficient, and effective ophthalmic anesthesia is essential in the deliver of VR surgical care, and VR surgical techniques have become less invasive with the emergence of smaller incisions and less scleral buckles as well as a shift to ambulatory surgical centers. However, data is sparse with respect to assessing current anesthesia practices. A previous study from the UK that explored anesthesia practices in vitreoretinal surgery comprised multiple centers, 160 surgeons, and 12,000 operations. The findings included noting that VR surgeries were performed under general anesthesia and the other half under local anesthesia. However, the percentage of surgeries performed under general anesthesia dropped perceptibly from 95% in 2001 to 41% in 2010. In this current study, the researchers queried 2,638 retinal specialists regarding anesthesia practices.

Following an analysis of survey data, they found that cumulative response rate was 23% (597/2,638). Of the 556 respondents who regularly perform surgery, regional anesthesia was more commonly administered by ophthalmologists than anesthesiologists. Intraconal anesthesia was used in 319/555 (57%) of cases and was more commonly used in the U.S. than non-US countries where extraconal and sub-Tenon’s anesthesia were more common (P<0.001). While regional anesthesia with monitored anesthesia care (MAC) was preferred most vitreoretinal surgeries, GA was more often used in scleral buckling and trauma including corneal and scleral lacerations or any foreign bodies found in the eye.

“Regional anesthesia with MAC is the most common method for vitreoretinal procedures,” the authors wrote, “except in scleral buckling and trauma where GA is used more frequently.”

Sridhar J. Current Trends in Vitreoretinal Anesthesia. Presented at the 37^th ASRS Annual Meeting; July 26-30, 2019; Chicago, IL.

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