"The entire experience was very pleasant," he says. So pleasant, in
fact, that he chose oral sedation for subsequent surgeries performed on
his wife and mother-in-law.
Proponents of IV-free eye surgery tout its potential to please
patients and improve clinical workflows, while others point to cost
and safety concerns as reasons to stick with intravenous sedation.
Here's a look at both sides.
Plenty of positives
Dr. Greenwood says IV-free cataract surgery is an efficient sedation
option in ophthalmology, a specialty where every minute counts,
including those minutes spent trying to start IVs when first-stick suc-
cess is never a guarantee.
His patients receive 1 to 2 tablets based primarily on age: 2 for those
under 65 years; 1.5 for those 65 to 75 and 1 for those over 75. (You can
order the tablets in bulk from a 503B outsourcing pharmacy and
administer them to patients without needing individual prescriptions.)
Dr. Greenwood says the tablets provide a consistent sedation,
adding to his confidence as he performs surgery. In addition, he says,
patients experience a euphoric high from the ketamine, which softens
the discomforting sensations of surgery, including staring into the
bright light of the surgical microscope.
William Wiley, MD, medical director of the Cleveland (Ohio) Eye
Clinic, says inconsistencies in the timing of sedating cataract patients
can occur when nurses start IVs and wait for anesthesia to administer
midazolam, with doses varying from provider to provider. He points
out that nurses, without waiting for anesthesia, can time the adminis-
tration of sublingual sedation in pre-op, so patients are feeling its
calming effects before they're wheeled back to the OR and are fully
sedated when surgery starts.
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