Anesthesia monitoring by registered nurses during cataract surgery: Assessment of need for intraoperative anesthesia consultation

Purpose

To assess the frequency and risk factors for intraoperative anesthesia consultation when performing cataract surgery monitored by registered nurses.

Setting

Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, USA

Methods

This retrospective review was of 270 cataract surgeries performed under local anesthesia from April 1, 2002, to April 1, 2003.

Results

The American Society of Anesthesiologists (ASA) classification of each patient was determined: 1 patient was classified as ASA 1. One hundred fifty patients were classified as ASA 2. One hundred nineteen patients were classified as ASA 3. The anesthesiology department was consulted 24 times. Nineteen consultations involved patients who were ASA 3, and 5 consultations involved patients who were ASA 2 (P<.001). In most cases (23 of 24), the anesthesia service provided a consultation (eg, increase oxygen flow rate, clarification of electrocardiogram, start intravenous line, equipment repair) and left the nurses to continue to monitor the patient. In only 1 case (ASA 3), the anesthesia service converted the case to monitored anesthesia care and relieved the nurse to monitor the patient.

Conclusions

In this study, monitoring of routine cataract surgery by registered nurses was associated with a low rate of intraoperative anesthesia consultation. Most consultations resulted in little intervention. The ASA classification appears predictive of the need for intraoperative anesthesia consultation.