Prepared by:
Johns Hopkins University Evidence-based Practice Center
Oliver D. Schein, M.D., M.P.H.
Principal Investigator
David S. Friedman, M.D., M.P.H.
Lee A. Fleisher, M.D.
Co-Principal Investigators
Lisa H. Lubomski, Ph.D.
Jeffrey Magaziner, M.D.
Michael Sprintz, M.D.
John Kempen, M.D., M.P.H.
Sherman W. Reeves
Karen A. Robinson, M.Sc.
Eric B. Bass, M.D., M.P.H.
Investigators
File Name Description Software Version File Size __________________________________________________________________________________________________________ 01front.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 35KB 10 pages Contents: Volume 1 Title Page, Preface, Structured Abstract, Table of Contents __________________________________________________________________________________________________________ 02summ.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 21KB 4 pages Contents: Summary: Overview, Reporting the Evidence, Methodology, Findings, Future Research __________________________________________________________________________________________________________ 03chap1.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 8KB 3 pages Contents: Chapter 1. Introduction: Background, Purpose of Evidence Report __________________________________________________________________________________________________________ 04chap2.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 41KB 9 pages Contents: Chapter 2. Methodology: Recruitment of Experts, Patient Population, Identifying the Specific Questions, Causal Pathway, Literature Search Methods, Article Review, Summary Evidence Tables, Synthesis Tables, Grading the Evidence, Meta-analysis, Supplemental Analyses, Peer Review __________________________________________________________________________________________________________ 05chap3.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 150KB 24 pages Contents: Chapter 3. Results: Results of the Literature Search and Abstract Review, Results of the Studies, Assessment of the Strength of the Evidence __________________________________________________________________________________________________________ 06chap4.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 21KB 4 pages Contents: Chapter 4. Conclusions: Conclusions Regarding Local Anesthesia Techniques, Conclusions Regarding Sedation Strategies __________________________________________________________________________________________________________ 07chap5.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 8KB 1 page Contents: Chapter 5. Future Research __________________________________________________________________________________________________________ 08refs.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 52KB 9 pages Contents: References __________________________________________________________________________________________________________ 09suppl.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 48KB 8 pages Contents: Supplemental Analyses __________________________________________________________________________________________________________ 10appa.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 6KB 1 pages Contents: Appendix A. Peer Reviewers __________________________________________________________________________________________________________ 11appb.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 19KB 6 pages Contents: Appendix B. Question Refinement Mailing __________________________________________________________________________________________________________ 12appc.ppt MS PowerPoint® Presentation MS PowerPoint® 2000 25KB 1 page Contents: Appendix C. Causal Pathway of Anesthesia Management for Cataract Surgery __________________________________________________________________________________________________________ 13appd.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 14KB 4 pages Contents: Appendix D. Search Strategies __________________________________________________________________________________________________________ 14appe.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 8KB 1 page Contents: Appendix E. List of Hand-Searched Journals __________________________________________________________________________________________________________ 15appf.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 14KB 1 page Contents: Appendix F. Abstract Review Form __________________________________________________________________________________________________________ 16appg.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 37KB 7 pages Contents: Appendix G. Article Quality Assessment Form __________________________________________________________________________________________________________ 17apph.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 395KB 54 pages Contents: Appendix H. Article Content Abstraction Form __________________________________________________________________________________________________________ 18appi.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 25KB 2 pages Contents: Appendix I. Questions for Literature Synthesis __________________________________________________________________________________________________________ 19appj.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 17KB 2 pages Contents: Appendix J. Peer Review Response Form for Draft Report __________________________________________________________________________________________________________ 20appk.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 15KB 1 page Contents: Appendix K. Summary of Searches __________________________________________________________________________________________________________ 21appl.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 15KB 2 pages Contents: Appendix L. Abstract Review Summary __________________________________________________________________________________________________________ 22appm.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 21KB 4 pages Contents: Appendix M. Articles Excluded During Full Article Abstraction __________________________________________________________________________________________________________ 23appn.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 12KB 1 page Contents: Appendix N. Reasons for Article Exclusion __________________________________________________________________________________________________________ 24appo.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 12KB 1 page Contents: Appendix O. Summary of Quality Review __________________________________________________________________________________________________________ 25appp.ppt MS PowerPoint® Presentation MS PowerPoint® 2000 45KB 1 page Contents: Appendix P. Decision Tree __________________________________________________________________________________________________________ 26appq.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 28KB 5 pages Contents: Appendix Q. Decision Analysis Tables __________________________________________________________________________________________________________ 27appr.ppt MS PowerPoint® Presentation MS PowerPoint® 2000 29KB 1 page Contents: Appendix R. Average Expected Cost Versus Average Expected Preference Value for Six Anesthesia Scenarios __________________________________________________________________________________________________________ 28apps.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 11KB 1 page Contents: Appendix S. Medicare Claims Analysis Tables __________________________________________________________________________________________________________ 29frntv2.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 31KB 5 pages Contents: Volume 2 Title Page, Table of Contents __________________________________________________________________________________________________________ 30etacro.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 7KB 2 pages Contents: Acronyms and Abbreviations Used in the Evidence Tables __________________________________________________________________________________________________________ 31etbl1.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 179KB 70 pages Contents: Evidence Table 1. Overall summary of literature on anesthesia for cataract surgery __________________________________________________________________________________________________________ 32etbl2.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 335KB 95 pages Contents: Evidence Table 2. Summary of interventions reported in literature on anesthesia for cataract surgery __________________________________________________________________________________________________________ 33etbl3.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 103KB 23 pages Contents: Evidence Table 3. Methodologic quality of literature on anesthesia for cataract surgery __________________________________________________________________________________________________________ 34etbl4.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 16KB 2 pages Contents: Evidence Table 4. Local anesthesia: Is there evidence that a retrobulbar block is more effective at producing akinesia than a peribulbar block? __________________________________________________________________________________________________________ 35etbl5.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 8KB 1 page Contents: Evidence Table 5. Local anesthesia: Is there evidence that a retrobulbar block is more effective at producing akinesia than a subconjunctival/sub-Tenon's block? __________________________________________________________________________________________________________ 36etbl6.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 8KB 1 page Contents: Evidence Table 6. Local anesthesia: Is there evidence that a peribulbar block is more effective at producing akinesia than a subconjunctival/sub-Tenon's block? __________________________________________________________________________________________________________ 37etbl7.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 44KB 9 pages Contents: Evidence Table 7. Local anesthesia: Is there evidence of the effectiveness of a peribulbar block at producing akinesia? __________________________________________________________________________________________________________ 38etbl8.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 30KB 5 pages Contents: Evidence Table 8. Local anesthesia: Is there evidence of the effectiveness of a retrobulbar block at producing akinesia? __________________________________________________________________________________________________________ 39etbl9.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 7KB 1 page Contents: Evidence Table 9. Local anesthesia: Is there evidence of the effectiveness of a subconjunctival/sub-Tenon's block in producing akinesia? __________________________________________________________________________________________________________ 40etbl10.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 30KB 3 pages Contents: Evidence Table 10. Local anesthesia: Is there evidence that adding hyaluronidase to local blocks produces better akinesia than not adding hyaluronidase? __________________________________________________________________________________________________________ 41etbl11.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 22KB 2 pages Contents: Evidence Table 11. Local anesthesia: Is there evidence that certain anesthetic agents used in local blocks produce better akinesia? __________________________________________________________________________________________________________ 42etbl12.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 12KB 2 pages Contents: Evidence Table 12. Local anesthesia: Is there evidence that the volume of anesthetic used and speed of injection affect the amount of akinesia obtained and pain during the block or surgery with local blocks? __________________________________________________________________________________________________________ 43etbl13.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 14KB 1 page Contents: Evidence Table 13. Local anesthesia: Is there evidence that the retrobulbar block technique is more or less painful than the peribulbar block during administration of the block? __________________________________________________________________________________________________________ 44etbl14.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 13KB 1 page Contents: Evidence Table 14. Local anesthesia: Is there evidence that retrobulbar block techniques are more painful for the patient while being administered than subconjunctival/sub-Tenon's block techniques? __________________________________________________________________________________________________________ 45etbl15.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 10KB 1 page Contents: Evidence Table 15. Local anesthesia: Is there evidence that peribulbar block techniques are more painful for the patient while being administered than subconjunctival/sub-Tenon's block techniques? __________________________________________________________________________________________________________ 46etbl16.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 45KB 4 pages Contents: Evidence Table 16. Local anesthesia: Summary of evidence regarding pain during administration of peribulbar block __________________________________________________________________________________________________________ 47etbl17.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 32KB 2 pages Contents: Evidence Table 17. Local anesthesia: Summary of evidence regarding pain during administration of retrobulbar block __________________________________________________________________________________________________________ 48etbl18.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 7KB 1 page Contents: Evidence Table 18. Local anesthesia: Summary of evidence regarding pain during administration of subconjunctival/sub-Tenon's block __________________________________________________________________________________________________________ 49etbl19.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 9KB 1 page Contents: Evidence Table 19. Local anesthesia: Is there evidence that retrobulbar block is more or less painful for the patient during administration than topical block? __________________________________________________________________________________________________________ 50etbl20.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 12KB 1 page Contents: Evidence Table 20. Local anesthesia: Is there evidence that peribulbar block is more or less painful for the patient while being administered than topical block? __________________________________________________________________________________________________________ 51etbl21.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 8KB 1 page Contents: Evidence Table 21. Local anesthesia: Is there evidence that subconjunctival/sub-Tenon's block is more or less painful to the patient during administration than topical block? __________________________________________________________________________________________________________ 52etbl22.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 14KB 1 page Contents: Evidence Table 22. Local anesthesia: Is there evidence that retrobulbar block techniques result in more or less pain during cataract surgery than peribulbar block techniques? __________________________________________________________________________________________________________ 53etbl23.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 12KB 1 page Contents: Evidence Table 23. Local anesthesia: Is there evidence that retrobulbar block techniques result in more or less pain during cataract surgery than subconjunctival/sub-Tenon's techniques? __________________________________________________________________________________________________________ 54etbl24.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 7KB 1 page Contents: Evidence Table 24. Local anesthesia: Is there evidence that peribulbar block techniques result in more or less pain during cataract surgery than subconjunctival/sub-Tenon's block techniques? __________________________________________________________________________________________________________ 55etbl25.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 47KB 6 pages Contents: Evidence Table 25. Local anesthesia: Summary of the evidence regarding pain during cataract surgery after peribulbar block __________________________________________________________________________________________________________ 56etbl26.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 19KB 2 pages Contents: Evidence Table 26. Local anesthesia: Summary of the evidence regarding pain during cataract surgery after retrobulbar block __________________________________________________________________________________________________________ 57etbl27.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 9KB 1 page Contents: Evidence Table 27. Local anesthesia: Summary of the evidence regarding pain during cataract surgery after subconjunctival/sub-Tenon's injection __________________________________________________________________________________________________________ 58etbl28.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 14KB 1 page Contents: Evidence Table 28. Local anesthesia: Is there evidence that retrobulbar block techniques result in more or less pain during cataract surgery than topical block? __________________________________________________________________________________________________________ 59etbl29.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 11KB 1 page Contents: Evidence Table 29. Local anesthesia: Is there evidence that peribulbar block techniques result in more or less pain during cataract surgery than topical block techniques? __________________________________________________________________________________________________________ 60etbl30.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 10KB 1 page Contents: Evidence Table 30. Local anesthesia: Is there evidence that subconjunctival/sub-Tenon's block techniques result in more or less pain during cataract surgery than topical block techniques? __________________________________________________________________________________________________________ 61etbl31.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 14KB 2 pages Contents: Evidence Table 31. Local anesthesia: Is pain control improved by adding intracameral lidocaine to topical anesthesia? __________________________________________________________________________________________________________ 62etbl32.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 10KB 1 page Contents: Evidence Table 32. Local anesthesia: Is there evidence that using hyaluronidase reduces the amount of pain experienced by the patient during cataract surgery? __________________________________________________________________________________________________________ 63etbl33.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 16KB 2 pages Contents: Evidence Table 33. Local anesthesia: Is there evidence that certain anesthetic agents result in more or less pain during cataract surgery than other agents? __________________________________________________________________________________________________________ 64etbl34.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 8KB 1 page Contents: Evidence Table 34. Local anesthesia: Is there evidence that warming of the anesthetic agents results in improved akinesia or pain control during the block and during the operation? __________________________________________________________________________________________________________ 65etbl35.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 10KB 1 page Contents: Evidence Table 35. Local anesthesia: Is there evidence that pH adjustment yields more effective local blocks? __________________________________________________________________________________________________________ 66etbl36.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 79KB 17 pages Contents: Evidence Table 36. Local anesthesia: Summary of the evidence regarding complications of retrobulbar blocks __________________________________________________________________________________________________________ 67etbl37.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 85KB 18 pages Contents: Evidence Table 37. Local anesthesia: Summary of the evidence regarding complications of peribulbar blocks __________________________________________________________________________________________________________ 68etbl38.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 25KB 4 pages Contents: Evidence Table 38. Local anesthesia: Summary of the evidence on complication rates with subconjunctival anesthesia __________________________________________________________________________________________________________ 69etbl39.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 24KB 4 pages Contents: Evidence Table 39. Local anesthesia: Summary of the evidence on complication rates with topical anesthesia __________________________________________________________________________________________________________ 70etbl40.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 11KB 1 page Contents: Evidence Table 40. Sedation: Is sedation associated with improved pain control/ patient cooperation compared to local anesthesia alone? __________________________________________________________________________________________________________ 71etbl41.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 8KB 1 page Contents: Evidence Table 41. Sedation: Is sedation associated with improved anxiety control/ patient satisfaction compared to local anesthesia alone? __________________________________________________________________________________________________________ 72etbl42.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 8KB 1 page Contents: Evidence Table 42. Sedation: Is sedation associated with improved hemodynamics outcomes compared to local anesthesia alone? __________________________________________________________________________________________________________ 73etbl43.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 19KB 3 pages Contents: Evidence Table 43. Sedation: Summary of evidence on the effectiveness of oral and intramuscular sedation regarding patient cooperation and pain __________________________________________________________________________________________________________ 74etbl44.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 9KB 1 page Contents: Evidence Table 44. Sedation: Summary of evidence on the effectiveness of oral and intramuscular sedation regarding anxiety and satisfaction __________________________________________________________________________________________________________ 75etbl45.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 16KB 4 pages Contents: Evidence Table 45. Sedation: Summary of evidence on the effectiveness of oral or intramuscular sedation regarding medical and hemodynamic complications __________________________________________________________________________________________________________ 76etbl46.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 32KB 6 pages Contents: Evidence Table 46. Sedation: Summary of evidence on the effectiveness of intravenous sedation regarding patient cooperation and pain __________________________________________________________________________________________________________ 77etbl47.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 18KB 2 pages Contents: Evidence Table 47. Sedation: Summary of evidence on the effectiveness of intravenous sedation regarding patient anxiety and satisfaction __________________________________________________________________________________________________________ 78etbl48.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 16KB 4 pages Contents: Evidence Table 48. Sedation: Summary of evidence on the effectiveness of intravenous sedation regarding medical outcomes and complications __________________________________________________________________________________________________________ 79etbl49.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 18KB 2 pages Contents: Evidence Table 49. Sedation: Comparison of intravenous agents regarding patient cooperation and pain __________________________________________________________________________________________________________ 80etbl50.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 10KB 1 page Contents: Evidence Table 50. Sedation: Comparison of intravenous agents regarding anxiety control and satisfaction __________________________________________________________________________________________________________ 81etbl51.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 13KB 3 pages Contents: Evidence Table 51. Sedation: Comparison of intravenous agents regarding medical complications and hemodynamics __________________________________________________________________________________________________________ 82etbl52.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 7KB 1 page Contents: Evidence Table 52. Sedation: Safety and effectiveness of patient-controlled anesthesia regarding pain and cooperation __________________________________________________________________________________________________________ 83etbl53.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 7KB 1 page Contents: Evidence Table 53. Sedation: Safety and effectiveness of patient-controlled anesthesia regarding medical complications and hemodynamics __________________________________________________________________________________________________________ 84biblio.wpd Corel WordPerfect® Document Corel WordPerfect® 6/7/8/9/10 63KB 10 pages Contents: Bibliography __________________________________________________________________________________________________________
AHRQ Publication No. 01-E017
Current as of August 2001
Internet Citation:
Anesthesia Management During Cataract Surgery. File Inventory, Evidence Report/Technology Assessment Number 16. AHRQ Publication No. 01-E017, August 2001. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/cataninv.htm
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