Zusammenfassung
Mit der Etablierung der modernen Kataraktchirurgie als Operation in einem geschlossenen System wurde die topische Anästhesie eingeführt. Die alleinige Tropfanästhesie ermöglicht zwar eine gute Analgesie in den meisten Fällen. Bis zu 30 % der Patienten fühlen sich jedoch während der einzelnen Operationsschritte unwohl und berichten von Schmerzen, die gerade noch erträglich sind. Die Oberflächenanästhesie kann durch Modifikation der Applikationsformen wie Schwämmchen, Gel oder mit der subkonjunktivalen Anästhesie intensiviert werden. Mit der Einführung der intrakameralen Anästhesie in den 90er-Jahren, vor allem mit unkonserviertem Lidocain 1 %, wurde die Effektivität der topischen Anästhesie signifikant verbessert, sodass diese kombinierte Anästhesie als Routineverfahren angewendet werden kann. Eine anästhesiologische Prämedikation und Überwachung ist eine sinnvolle Ergänzung der lokalen Anästhesie, da die meisten Kataraktpatienten häufig im hohen Alter sind und kardiovaskuläre Erkrankungen haben. An knapp 10 % der operierten Patienten können Beeinträchtigungen der kardiopulmonalen Parameter festgestellt werden. In ca. 2,6 % ist eine anästhesiologische Intervention notwendig.
Abstract
Topical anaesthesia was introduced together with the establishment of modern cataract surgery as an operation in a closed system. Superficial anaesthesia by itself leads to a good analgesia in most cases. However, up to 30 % of the patients feel uncomfortable or even experience pain during surgery. Superficial anaesthesia can be intensified with subconjunctival infiltration or by modifying the application forms such as sponges or gel. With the introduction of the intracameral anaesthesia in the 1990 s primarily with unpreserved lidocaine 1 %, the efficacy of the topical anaesthesia was improved significantly. The combined topical anaesthesia plus intracameral lidocaine administration can be used as a routine method. A general anaesthesia care for premedication and monitoring during cataract surgery is useful since most cataract patients are of advanced age and frequently suffer from cardiovascular diseases. In almost 10 % of the patients changes in cardiopulmonal comorbidities were observed and in 2.6 % anaesthesia intervention was required.
Schlüsselwörter
Kataraktchirurgie - topische Anästhesie - intrakamerale Anästhesie - Sedierung - Lidocain
Key words
cataract surgery - topical anaesthesia - intracameral anaesthesia - sedation - lidocaine
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Prof. Dr. Duy-Thoai Pham
Augenklinik, Vivantes Klinikum Neukölln
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