| V. ガイドライン | | | | IV.手術 | | | | 2.手術 | |
1)麻酔方法・麻酔剤 | | | |
勧告(ガイドライン) | | a | 白内障手術には、症例の難易度や術者の技量に合わせた麻酔方法を選択する(グレードB)。 |
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エビデンス |
白内障手術の麻酔方法に、全身麻酔と局所麻酔がある1)(IV)。
全身麻酔では術後吐き気、咽頭痛、ふらつき、血圧低下などの副作用がある2,3)(II-IV)。
また局所麻酔のほう方が代謝や心血管反応に対する影響が少ない4)(II)。
点眼麻酔は麻酔そのものに対するストレスは少ないが術中の疼痛が若干多く、患者の疼痛のため手術難易度が高くなるとされる5,6)(III)。
麻酔方法については各方法とも有用で、基本的には麻酔効果、白内障術後成績は変わらない7,8,9,10)(I, II, IV)。
前房内麻酔は点眼麻酔を選択した場合に麻酔効果が弱いときの補助として使われる11,12,13)(II-III)。
テノン嚢麻酔は麻酔後早期に眼圧を上昇させる作用がある14,15)(II-III)。
球後麻酔は鎮痛効果は強いが麻酔時の疼痛が強く、結膜下出血、眼瞼出血、球後出血などの副作用がある16,17,18)。
麻酔の前投薬には疼痛・不安を減少させる作用があるが吐き気や嘔吐などの副作用が生じる可能性がある19)(IV)。 | | | | | | 1) | Norregaard JC, Schein OD, Bellan L, Black C, Alonso J, Bernth-Petersen P, Dunn E, Andersen TF, Espallargues M, Anderson GF: International variation in anesthesia care during cataract surgery: results from the International Cataract Surgery Outcomes Study. Arch Ophthalmol 115 (10): 1304-1308, 1997 | | 2) | Barker JP, Vafidis GC, Hall GM: Postoperative morbidity following cataract surgery. A comparison of local and general anaesthesia. Anaesthesia 51 (5): 435-437, 1996 | | 3) | Campbell DN, Lim M, Muir MK, O'Sullivan G, Falcon M, Fison P, Woods R: A prospective randomised study of local versus general anaesthesia for cataract surgery. Anaesthesia 48 (5): 422-428, 1993 | | 4) | Barker JP, Vafidis GC, Robinson PN, Hall GM: Plasma catecholamine response to cataract surgery: a comparison between general and local anaesthesia. Anaesthesia 46 (8): 642-645, 1991 | | 5) | Boezaart A, Berry R, Nell M: Topical anesthesia versus retrobulbar block for cataract surgery: the patients' perspective. J Clin Anesth 12 (1): 58-60, 2000 | | 6) | Uusitalo RJ, Maunuksela EL, Paloheimo M, Kallio H, Laatikainen L: Converting to topical anesthesia in cataract surgery. J Cataract Refract Surg 25 (3): 432-440, 1999 | | 7) | Friedman DS, Bass EB, Lubomski LH, Fleisher LA, Kempen JH, Magaziner J, Sprintz M, Robinson K, Schein OD: Synthesis of the literature on the effectiveness of regional anesthesia for cataract surgery. Ophthalmology 108 (3): 519-529, 2001 | | 8) | Ripart J, Lefrant JY, Vivien B, Charavel P, Fabbro-Peray P, Jaussaud A, Dupeyron G, Eledjam JJ: Ophthalmic regional anesthesia: medial canthus episcleral (sub-tenon) anesthesia is more efficient than peribulbar anesthesia: A double-blind randomized study. Anesthesiology 92 (5): 1278-1285, 2000 | | 9) | Nielsen PJ, Allerod CW: Evaluation of local anesthesia techniques for small incision cataract surgery. J Cataract Refract Surg 24 (8): 1136-1144, 1998 | | 10) | Shammas HJ, Milkie M, Yeo R: Topical and subconjunctival anesthesia for phacoemulsification: prospective study. J Cataract Refract Surg 23 (10): 1577-1580, 1997 | | 11) | Boulton JE, Lopatatzidis A, Luck J, Baer RM: A randomized controlled trial of intracameral lidocaine during phacoemulsification under topical anesthesia. Ophthalmology 107 (1): 68-71, 2000 | | 12) | Crandall AS, Zabriskie NA, Patel BC, Burns TA, Mamalis N, Malmquist-Carter LA, Yee R: A comparison of patient comfort during cataract surgery with topical anesthesia versus topical anesthesia and intracameral lidocaine. Ophthalmology 106 (1): 60-66, 1999 | | 13) | Tseng SH, Chen FK: A randomized clinical trial of combined topical-intracameral anesthesia in cataract surgery. Ophthalmology 105 (11): 2007-2011, 1998 | | 14) | Azmon B, Alster Y, Lazar M, Geyer O: Effectiveness of sub-Tenon's versus peribulbar anesthesia in extracapsular cataract surgery. J Cataract Refract Surg 25 (12): 1646-1650, 1999 | | 15) | Sanford DK, Minoso y de Cal OE, Belyea DA: Response of intraocular pressure to retrobulbar and peribulbar anesthesia. Ophthalmic Surg Lasers 29 (10): 815-817, 1998 | | 16) | Patel BC, Clinch TE, Burns TA, Shomaker ST, Jessen R, Crandall AS: Prospective evaluation of topical versus retrobulbar anesthesia: a converting surgeon's experience. J Cataract Refract Surg 24 (6): 853-860, 1998 | | 17) | Khoo BK, Lim TH, Yong V: Sub-Tenon's versus retrobulbar anesthesia for cataract surgery. Ophthalmic Surg Lasers 27 (9): 773-777, 1996 | | 18) | Patel BC, Burns TA, Crandall A, Shomaker ST, Pace NL, van Eerd A, Clinch T: A comparison of topical and retrobulbar anesthesia for cataract surgery. Ophthalmology 103 (8): 1196-1203, 1996 | | 19) | Katz J, Feldman MA, Bass EB, Lubomski LH, Tielsch JM, Petty BG, Fleisher LA, Schein OD: Injectable versus topical anesthesia for cataract surgery: patient perceptions of pain and side effects. The Study of Medical Testing for Cataract Surgery study team. Ophthalmology 107 (11): 2054-2060, 2000 |
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その他の参考文献 | | ・ | Friedman DS, Bass EB, Lubomski LH, Fleisher LA, Kempen JH, Magaziner J, Sprintz M, Robinson K, Schein OD: The methodologic quality of clinical trials on regional anesthesia for cataract surgery. Ophthalmology 108 (3): 530-541, 2001 | | ・ | Luchetti M, Magni G, Marraro G: A prospective randomized double-blinded controlled study of ropivacaine 0.75% versus bupivacaine 0.5%-mepivacaine 2% for peribulbar anesthesia. Reg Anesth Pain Med 25 (2): 195-200, 2000 | | ・ | Patel BC, Clinch TE, Burns TA, Shomaker ST, Jessen R, Crandall AS: Prospective evaluation of topical versus retrobulbar anesthesia: a converting surgeon's experience. J Cataract Refract Surg 24 (6): 853-860, 1998 | | ・ | Maclean H, Burton T, Murray A: Patient comfort during cataract surgery with modified topical and peribulbar anesthesia. J Cataract Refract Surg 23 (2): 277-283, 1997 | | ・ | Wong DH, Merrick PM: Intravenous sedation prior to peribulbar anaesthesia for cataract surgery in elderly patients.Can J Anaesth 43 (11): 1115-1120, 1996 | | ・ | Zehetmayer M, Radax U, Skorpik C, Menapace R, Schemper M, Weghaupt H, Scholz U: Topical versus peribulbar anesthesia in clear corneal cataract surgery. J Cataract Refract Surg 22 (4): 480-484, 1996 | | ・ | Khurana AK, Sachdeva RK, Gombar KK, Ahluwalia BK: Evaluation of subconjunctival anaesthesia vs peribulbar anaesthesia in cataract surgery. Acta Ophthalmol (Copenh) 72 (6): 727-730, 1994 | | ・ | Ali-Melkkila TM, Virkkila M, Jyrkkio H: Regional anesthesia for cataract surgery: comparison of retrobulbar and peribulbar techniques. Reg Anesth 17 (4): 219-222, 1992 | | ・ | Tokuda Y, Oshika T, Amano S, Inouye J, Yoshitomi F: Analgesic effects of sub-Tenon's versus retrobulbar anesthesia in planned extracapsular cataract extraction. Graefes Arch Clin Exp Ophthalmol 238 (3): 228-231, 2000 | | ・ | Naor J, Slomovic AR: Anesthesia modalities for cataract surgery. Curr Opin Ophthalmol 11 (1): 7-11, 2000 | | ・ | Tokuda Y, Oshika T, Amano S, Yoshitomi F, Inouye J: Anesthetic dose and analgesic effects of sub-Tenon's anesthesia in cataract surgery. J Cataract Refract Surg 25 (9): 1250-1253, 1999 | | ・ | Dinsmore SC: Approaching a 100% success rate using topical anesthesia with mild intravenous sedation in phacoemulsification procedures. Ophthalmic Surg Lasers 27 (11): 935-938, 1996 |
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