2982: next time just do an anesthetic block!
This video highlights a patient who had an insufficient degree of sedation and was not a great candidate for topical anesthesia cataract surgery because she moved around so much during the procedure. In cases like this, it is much easier to just perform an anesthetic block such as a subtenons, retrobulbar, or peribulbar block to ensure akinesia and analgesia. Alternatively, providing more intravenous sedation like midazolam can help calm an anxious or uncooperative patient. Another excellent safety technique is to actively fixate the eye with the nondominant hand by hooking the paracentesis with the phaco chopper. This crucial step ensures that a sudden, unexpected eye movement does not cause the severe capsulorhexis runaway or tear issue shown in the photo. What is your go to strategy when a patient under topical anesthesia starts moving excessively? Please comment your thoughts below.
