LETTER TO EDITOR
Year : 2014 | Volume
: 58 | Issue : 2 | Page : 231--232
Prevalence and indications of general anesthesia for adult cataracts in a tertiary care centre in India
Sudarshan Khokhar, Shikha Gupta, Anasua Ganguly, Dilip Shende
Department of Ophthalmology and Anaesthesiology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi - 110 029
|How to cite this article:|
Khokhar S, Gupta S, Ganguly A, Shende D. Prevalence and indications of general anesthesia for adult cataracts in a tertiary care centre in India.Indian J Anaesth 2014;58:231-232
|How to cite this URL:|
Khokhar S, Gupta S, Ganguly A, Shende D. Prevalence and indications of general anesthesia for adult cataracts in a tertiary care centre in India. Indian J Anaesth [serial online] 2014 [cited 2020 Aug 4 ];58:231-232
Available from: http://www.ijaweb.org/text.asp?2014/58/2/231/130858
Current anesthesia options for cataract surgery include regional anesthesia (retrobulbar, peribulbar or sub-tenon), topical anesthesia and general anesthesia. Though there are differences in the preferences, and practices of ophthalmic anesthesia,  regional or topical anesthesia are preferred modalities in adults. This study was conducted to evaluate the prevalence and indications of providing general anaesthesia for cataract surgery in adults at a tertiary care centre in northern India.
A retrospective review of records of surgeries performed on patients presenting to the lens clinic at our tertiary care centre was done over a 10 year period from June 2003 to May 2012. Charts were reviewed for number of adults undergoing cataract surgery, type of anaesthesia administered, indications for surgery, age and gender. Patients requiring cardiopulmonary monitoring due to associated co-morbidities who were operated under local anaesthesia were considered into local anaesthesia group.
The total number of patients undergoing cataract surgery over the study period was 25,246 of which 2883 (11.42%) required general anaesthesia; 13 of these were adults (0.0514% of total; 0.45% of total general anaesthesia patients). Mean age of the patients was 23.07 years (range 17 to 35). Among these, 8 (61.53%) were males and 5 (38.46%) were females. The most common indication for using general anaesthesia was mental retardation in 61.55% (8/13), secondary to Down's syndrome (3), cerebral palsy (2), congenital rubella syndrome (1), tuberous sclerosis (1) and perinatal hypoxia (1). Other indications comprised of one case each of schizophrenia, seizure disorder, head nodding, nystagmus and hypersensitivity to local anesthetic agents (8.33% each).
Advances in cataract surgery techniques have ushered in an era of regional ocular anaesthesia. Past evidence suggested absolute patient immobility with safety equivalent to local anaesthesia (LA) with general anaesthesia (GA).  However, with the advent of phacoemulsification, cataract surgery has become safer and faster, resulting in diminished need for absolute akinesia and anaesthesia. Complications like peri-operative myocardial ischemia, pneumothorax, hormonal, metabolic and haemodynamic instability associated with GA in elderly patients undergoing cataract surgery have been reported.  Consequently, GA as well as retrobulbar block have largely been replaced with other means of LA.  The prevalence of GA for cataract surgery over 10 year period was 11.42%; majority of which was used for paediatric cataract and that for adults it was 0.05% in our setting. Chen et al.  reported a 3.71% prevalence of GA use in cataract surgery in United Kingdom, which is consistent with the 4.54% prevalence at Cataract National Dataset. 
We found that GA in adults was mainly essential in cases of mental restrictions, uncontrolled neurological movements (involving head) and allergy to LA. Despite the higher costs and potential risks of GA, it may be indicated in the above conditions and these conditions should be looked into, both by the anaesthesiologists and ophthalmologists, before planning to take them for cataract surgery.
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|2||Campbell DN, Lim M, Muir MK, O'Sullivan G, Falcon M, Fison P, et al. A prospectiv e randomised study of local versus general anaesthesia for cataract surgery. Anaesthesia 1993;48:422-8.|
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