4. Pupil expanders. Nothing slows a case to a crawl more
than a pupil that won't dilate. Fortunately, there's no short-
age of pupil expanders that keep small pupils open dur-
ing surgery: Malyugin rings, iris hooks (retractors) and
compounded Shugarcaine.
"Using the pupil expander has been the difference
between a hard case and one that the surgeon has greater
visibility of the lens and ease of removal," says Ms.
Haskell.
Dr. Weston says Shugarcaine works well for small
pupils. "I think it's immoral to pay $450 for something
you squirt in the bottle that does at best no better," he
says.
"We use a Malyugin ring or a combination of phenyle-
phrine and lidocaine that we have compounded," says
Jennifer Brooks, RN, manager of the Virginia Beach (Va.)
Eye Center.
5. Stretcher chairs. Many eye centers shave valuable min-
utes off their case times by keeping patients on the same
eye cart or stretcher chair throughout the perioperative
process, thereby bypassing the need to transfer patients
onto and off of the OR bed. "The patient starts and has sur-
gery on the same cart," says Ms. Koppinger.
A key benefit of the powered surgical chair is that you
don't have to attach and reattach patient monitoring
equipment, says Jody Looker, RN, CNOR, director of the
Eye Surgery Center of Winchester (Va.). "We mount the
patient monitor directly onto the stretcher so we never
1 1 9
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