I prefer to perform cataract surgery with my patients under monitored sedation (this is different from general anaesthesia or GA). Monitored sedation is when patients are completely asleep (without the need for GA) and under the close monitoring of an anaesthetist.
Monitored sedation (unlike GA) is very safe, even for patients who have pre-existing medical conditions. I believe that patients have the best experience and are most comfortable when they are completely unaware of the ongoings of the surgery. My patients like the fact that they experience taking a short nap and upon waking, the surgery is all over.
Having the patient completely asleep means that the surgeon and anaesthetist need to be very good at controlling the patient’s eye and body movements during surgery. This is one of the reasons why other surgeons may choose to perform the surgery when the patient is awake and cooperative. They rely on the patient to keep their eye and body still and straight during the surgery.
In my experience, patients can get rather anxious about being awake during surgery and this anxiety may increase their blood pressure and affect their surgical outcome. What’s more, as expected, it may be difficult for patients to cooperate fully with the surgeon’s instructions during surgery through no fault of theirs.
As an experienced eye surgeon who strives for a perfect result, I prefer to be in total control of the surgery and not to rely on my patient’s cooperation for the perfect surgery outcome.
