Monitored anesthesia care by registered respiratory therapists during cataract surgery: an update.

Objective: To reevaluate the safety and practicality of registered respiratory therapists (RRTs) providing monitored anesthesia care during cataract surgery.

Design: Prospective observational cohort study.

Participants: A total of 15,440 consecutive patients undergoing phacoemulsification cataract surgery with intraocular lens insertion using topical anesthesia +/- intravenous (IV) sedation at 2 surgical centers.

Methods: Registered respiratory therapists, specially trained as anesthesia assistants, provided monitored anesthesia care during all stages of surgery, with an anesthesiologist immediately available for consultation as required.

Main Outcome Measures: The primary outcome measure was the rate of serious perioperative medical complications relating to the surgery and anesthesia. The secondary outcome measure was the rate (total and by stage of surgery) of anesthesiologist intervention, defined as consultation by the RRT to the attending anesthesiologist for any reason irrespective of the ultimate level of patient care rendered. Patient age and American Society of Anesthesiology (ASA) Physical Status (PS) score were also analyzed as potential predictors of the need for anesthesiologist intervention.

Results: There were no serious perioperative medical complications leading to death, endotracheal intubation, or postoperative hospitalization. A total of 395 cases (2.6%) required anesthesia intervention, with 257 (1.7%) occurring preoperatively, 140 (0.91%) occurring intraoperatively, and 5 occurring (0.03%) postoperatively. Seven cases required interventions at 2 different stages of surgery. Mean patient age in the anesthesiology intervention group (73.2 years) was greater than in the non-intervention group (71.2 years) (P = 0.0002), whereas patient age of > or =75 years correlated with a greater need for intervention (3.0%) than <75 years (2.2%) (P = 0.001). The mean ASA PS score was higher for cases requiring anesthesiology intervention (2.6) than for those not requiring intervention (2.2) (P<0.0001), and the intervention rate was significantly greater for cases with ASA ratings > or =3 (5.9%) compared with < or =2 (1.3%) (P<0.0001).

Conclusions: We have demonstrated that allowing RRTs to provide monitored anesthesia care during cataract surgery with an anesthesiologist available as required seems to be both safe (no serious medical complications in 15,440 cases) and practical (anesthesiology intervention rate of 2.6%).