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The ophthalmology department of our hospital successfully completed a high-risk cataract surgery with the assistance of the anesthesiology department
Author:xaszxyy  Release date:2018-09-03


    Recently, the ophthalmology department of our hospital combined with the anesthesiology department operated cataract phacoemulsification and intraocular lens implantation with unconventional anesthesia, successfully treated a special cataract old man who has a blood pressure of 240/110mmHg due to serious complications since he was treated late. With high medical ethics and superb medical skills, they polished the medical pledge of "health and life".
  

    On April 24, 2018, an 86-year-old man accompanied by his children came to the ophthalmology clinic. The old man had a headache, nausea, and vomiting for 3 days. He was turned to the neurology department and the gastroenterology department of major hospitals, but the symptoms had not been improved. Then he visited director of the ophthalmology department in Xi’an Central Hospital, Zhaojiang Du. After inspection, Director Du quickly judged that the root cause was the eye. It was because the patient did not treat cataracts in time, so that cataracts had developed into over-ripening period, and the cortex dissolved, leading to glaucoma. Many elderly people have a misunderstanding in their current concept. They believe that they can only receive operation after cataracts becomes matured. However, during the development of cataract, many complications such as glaucoma may occur, which will not only increase the difficulty of surgery, but also greatly reduce the surgical results. Just like this patient, after the cataract is over matured, not only the vision is left with light, but glaucoma and uveitis caused by cortical dissolution can cause headaches, eye pain and other painful symptoms that are difficult to relieve.
  

    After hospitalization and drug treatment, the patient's intraocular pressure was controlled. The symptoms of headache, eye pain, nausea and vomiting disappeared. But without surgery, the patient's vision was difficult to improve, and the intraocular pressure was difficult to control. However, the local conditions of the patient's eyes were very poor and the function of the corneal endothelial cells was extremely low. Surgery was very likely to cause complications such as degeneration of the corneal endothelium. Besides, the patient had high myopia. Therefore, the surgery was of great difficulty. After discussion, the department explained the condition to the family and informed the operation risk. After active perioperative preparation, they decided to perform phacoemulsification and intraocular lens implantation. However, due to emotional stress, the patient’s blood pressure rised smoothly before surgery, reaching 240/110mmHg. There were risk of explosive choroidal hemorrhage and even intracranial hemorrhage. Therefore, antihypertensive drugs were given intravenously, but the blood pressure was still high. 
  

    At this time, the team of anesthesiologists led by Director Xiaogang Cui demonstrated their superior anesthesia concepts and skills. They obtained a consensus on the patient's pre-anesthesia assessment: use conscious sedation anesthesia plus controlled blood pressure anesthesia. Awakening and sedation anesthesia can slightly inhibit the level of patient consciousness, relieve anxiety and fear, relieve pain and other noxious stimuli, improve patient comfort, and allow patients to breathe continuously. Since the tracheal intubation is not used to avoid respiratory irritation, the use of anesthetic agents can be reduced, and the patient is only in a light anesthesia state, and an anesthetic method for surgical analgesia is achieved. This method requires anaesthetist closely monitors the indicators of patients. Anesthesiologists are at greater risk and require more anesthesia techniques and experience. It was carried out by director Cui and Deputy Chief Physician Bin Li.
  

    A special operation in which a subject collaborates with each other was carried out in the quiet operating room, and everyone paid attention to it. As the anesthetic and antihypertensive drugs were pumped in by little by the infusion pump, the blood pressure on the ECG monitor dropped from 240 to 210, 205, 195... and finally dropped below 200! Everyone finally breathed a sigh of relief, blood pressure continued to decline steadily, 185, 170, 165 ..., reached the level of safety required for ophthalmic surgery, the operation began smoothly. With the strong support of the anesthesiology department, the ophthalmology team had double confidence. After Regular incision, perfect capsulorhexis, smooth ultrasonic nucleus, implantation of intraocular lens, surgery was over, and there was no complication occurred. The intraoperative anesthesia department examined the arterial blood gas analysis twice to minimize the risk of anesthesia. Before, during, and after surgery, the ophthalmologists explained the condition to the anxious waiting family three times, and made the humanization of the medical treatment perfect.
  

    After the operation, the elderly recovered and the whole family was very happy. The old man held each hand to see her medical staff, excitedly said: "I prayed for God bless before surgery, and the surgery was really smooth. You are God!”