Anesthesia for surgery

[jms1182]

For scleral buckle surgery which is more common - local or general?  I haven't discussed this with my doc yet but I would assume general.  Local would seem too scary - who would want to be awake for this?? Thanks.

[Forum-OD-MP]

yeah ganeral i think

[Ag-i-doc]

oops.  "general".  typo.

[JodieJ]

I believe that most retinal surgery on adults is performed using local anesthesia (retrobulbar block) and IV sedation (at least here in Chicago where I had surgery.)  If you choose this method, you will be asleep during the surgery and not remember anything about it, but your post-surgery recovery will be MUCH faster and more pleasant than with general anesthesia (e.g., much less chance of post-surgery nausea and vomiting).  IV sedation is also a lot safer than than general anesthesia (i.e., less risk of serious complications).

In Europe, the U.K. and most other countries, retinal surgery is usually done with only local anesthesia, so the patient is awake but feels no pain.  I had read so much about my procedure (vitrectomy with epiretinal membrane peel) presurgery that I didn't want to miss it, so begged my surgeon to let me skip the sedation.  I felt no pain at all, and I was actually able to see the procedure being performed!  It was a thrilling (and hopefully once-in-a-lifetime) experience, but obviously not for everybody.

If you have concerns, I'm sure that you'll be able to discuss them with your surgeon and anesthesiologist.

[jms1182]

I had thought that general was IV sedation...
For local, I would be afraid of moving my eye during surgery and risk injuring myself (unless you are unable to move your eye).  I will definitely talk to my doc about it. Thanks!

[JodieJ]

Most retinal surgeons use retrobulbar blocks, which prevent eye movement.  IV sedation is not as "deep" as general anesthesia, but it's safer and probably the norm for retinal surgery in the US.

[Ag-i-doc]

what most patients want to know is:

"will i be awake?" (local only)

or

"will i be out?" (general, iv, etc)

but thank you for the claification.  very informative

[Felis]

IV sedation is considered local anesthesia. The patient will be awake during the surgery but his mental state is so dreamy that he won't be able to remember what happened during the surgery.

[K-D]

This was extremely confusing to me, as I wanted to be awake during my cataract surgery, and was told I would have a local.  To me, local always meant that you would be awake.  But I was told that I would have a local, Sodium Pentahol.  To me, Sodium Pentahol, is not a local.  Yet, apparently, as I was told, in eye surgery, they use the term, topical, for awake surgery.  And the term local, and general, means you are put under, general with assisted breathing.

[Ag-i-doc]

"IV sedation is considered local anesthesia. The patient will be awake during the surgery but his mental state is so dreamy that he won't be able to remember what happened during the surgery."

yes. please dont get caught up with semantics.  if a patient cannot remember the surgery, then most patients consider that being "out", even if technically it is local.

[JodieJ]

Sedation is not local anesthesia.  Local anesthesia is used to control pain.  The eye blocks (injections) used in retinal surgery are very effective at controlling pain.  It was my experience that the topical anesthesia (eye drops) used in cataract surgery is less effective.  (My surgeon warned me that I'd feel the ***** of a suture, and I sure did.)  Sedation is used for anxiety and to create amnesia for the surgical experience.  (Sometimes they do include a pain-killer like Fentenyl in the IV cocktail.)  But IV sedation is always used together with some type of local anesthesia (injection or eye drops) in eye surgery, or the patient would be squirming all over the operating table.  The alternative to local anesthesia/IV sedation is general anesthesia.

[JodieJ]

Did I get censured above???  I was referring to sensation of a needle penetrating the eye, not an offensive male.

[jms1182]

At least that made me laugh :)

[Ag-i-doc]

yeah the computer does that sometimes.  its not *me* censuring you...

it chooses some funny/weird things to cut out sometimes...

[JodieJ]

I figured it was a program censuring from a list of "unacceptable" words.  Wonder what else is on the list.

[K-D]

But Sodium Pentathol is not a sedation. It renders a person unconscience, not relaxed.  Because I refused it, although I asked several times for a sedative, I was given nothing.  And believe me.  I remember the whole situation.  I was given nothing.

[K-D]

oops  unconscious.

[JodieJ]

I've never heard of Sodium Pentathol used for cataract surgery.  At my surgery center, they used a combination of Versed and Fentenyl.  (Could you have heard incorrectly?)  I think that the goal is to give just enough to make the patient relaxed, but not enough to make him/her confused and/or unable to cooperate.

If you refuse the IV sedation (like we both did), all you get are the eye drops. During the surgery on my second eye, one of the little legs of the IOL got twisted, and the lens wouldn't unfold the way its supposed to.  My AcrySof IQ lens had been special ordered, and I knew (from the operating room conversation) that there wasn't a backup on hand. It was a real struggle lying still (and not having a panic attack) while my surgeon attempted to unfold the lens without ripping it.  He finally did, although I ended up with a very red eye and needed a suture to close the wound.  If I had to have repeat surgery, I think I'd go for the IV sedation.

[K-D]

Oh no Jodie.  I am sure it wwas Sodium Pentathol.  I am an R.N.  And I have taken many people for cataract surgery.  None of them were given this drug.  It renders a person unconscious. And I refused it.  It caused a big stink because I would not take it.  And I was not given any sedative which I requested 3 times.  I had to be NPO after midnight.  My surgery was scheduled for around noon.  I got there way before noon and was not operated on until 5pm.  It was a horrible experience, even though the actual surgery was very fast and not a problem. For 5 hours before the surgery, I was told by the Nurse that she was not sure that I would be operated upon, because I refused the Sodium Pentathol.  She then told me that I would have a big needle stuck in my eye..  Then after the surgery, I was told by the Recovery Room Nurse to continue to use the antibiotic drops that I had been told to use for 3 days before my surgery.  I told her that I had no such drops or had been told about them.  All and all, it was a horrible experience due to lack of communication and insisting that I take the Sodium Pentahol, which I refused and had to go into the operation with anxiety on a scale of 10 and was refused any sedative.

[JodieJ]

How horrible!  I was in and out of the surgery center in under 2 hours.  I'm sure you'll want to get all the details straight with your surgeon before surgery next time.

[K-D]

For sure Jodie.  I was in at 11:30am and out at 6 p.m. And much anxiety during that time, because I could not get a sedative, and refused the Sodium Pentathol.  Horrible experience!