ASSESSING VOCAL EMISSIONS OF PATIENTS UNDERGOING SUPERVISED RESIDENT CATARACT SURGRY

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ASSESSING VOCAL EMISSIONS OF PATIENTS UNDERGOING
SUPERVISED RESIDENT CATARACT SURGRY

• John M. Ramocki, M.D.
• Kresge Eye Institute
• Wayne State University
• Detroit, Michigan

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PURPOSE

• TO ASSESS WHETHER PATIENTS WHO TALK
  SIGNIFICANTLY DURING THEIR SUPERVISED RESIDENT
  CATARACT SURGERY WERE AT MORE RISK FOR
  COMPLICATIONS AND FOR PROLONGED SURGICAL TIME
  COMPARED TO PATIENTS WHO DID NOT TALK
  SIGNIFICANTLY DURING THEIR SUPERVISED RESIDENT
  CATARACT SURGERY.

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ANESTHESIA FOR CATARACT SURGERY HAS CHANGED OVER
THE PAST DECADES

• PRIOR DECADES- GENERAL ANESTHESIA
• LAST FEW DECADES LOCAL ANESTHESIA
• (LOCAL ANESTHESIA RETROBULBAR, PERIBULBAR)
• PAST DECADE- TOPICAL OR LOCAL

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PRESENT DAY ANESTHESIA FOR CATARACT SURGERY

• TOPICAL OR RETROBULAR BLOCKS-LIGHT SEDATION
• LIGHT SEDATION-LEAVES PATIENTS MORE WIDE AWAKE
• LIGHT SEDATION- PATIENTS TEND TO TALK DURING
  SURGERY

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LEVELS OF CONSCIOUSNESS FOR ANESTHESIA HAVE
CHANGED FOR CATARACT SURGERY OVER THE PAST FEW
DECADES

• GENERAL ANESTHESIA PAST DECADES HEAVY
  SEDATION
• RETROBULBAR RECENT DECADES MODERATE SEDATION
• TOPICAL OR LOCAL ANESTHESIA PRESENT DECADE
  LIGHT SEDATION

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TALKING BY THE PATIENT DURING SURGERY

• GENERAL ANESTHESIA- NO TALKING
• RETROBULBAR- MODERATE SEDATION- LESS TALKING
• TOPICAL AND RETROBULBAR MILD SEDATION- MORE
  TALKING

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TALKING BY THE PATIENT DURING CATARACT SURGERY IS
MORE PREVALENT NOWADAYS

• TOPICAL ANESTHESIA AND RETROBULBAR ANESTHESIA
  MORE FREQUENT NOW
• LESS SEDATION MORE FREQUENT NOW
• TALKING BY THE PATIENT MORE FREQUENT NOW

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TALKING BY THE PATIENT DURING CATARACT SURGERY IS
DISTRACTING FOR THE SURGEON

• PATIENT TALKS-OPERATIVE FIELD MOVES
• PATIENT TALKS-INTERRUPTS FLOW OF SURGERY
• PATIENT TALKS-RESULTS IN COMPLICATIONS?
• PATIENT TALKS-CAUSES PROLONGED O.R. TIME?

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NO STUDY PRESENT ANALYZING VOCAL EMISSIONS AND
COMPLICATIONS IN CATARACT SURGERY

• NONE STUDIED
• NONE REPORTED IN LITERATURE
• STUDIES ARE PRESENT DESCRIBING VISUAL EXPERIENCES
  DURING CATARACT SURGERY

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A BREAKDOWN OF DIFFERENT TYPES OF TALKING BY THE
PATIENT DURING CATARACT SURGERY CAN ANALYZE

• LENGTH OF TALKING- NUMBERS OF SENTENCES OR
  THOUGHTS
• TYPES OF TALKING- DESCRIBING PAIN, OTHER
  EXPERIENCES, DESIRES, OR THOUGHTS BY THE PATIENTS

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PARAMETER CHOSEN FOR ANALYZING TALKING BY THE
PATIENT WAS LENGTH OF TALKING

• AMOUNT OF TALKING BROKEN DOWN INTO
• MINIMAL OR NONE LESS THAN 10 LINES OF SPEECH
• SIGNIFICANT 10 OR MORE LINES OF SPEECH

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ANALYZING LENGTH OF TALKING BY THE PATIENT

• NUMBERS OF SENTENCES
• TRAINS OF THOUGHT
• LESS THAN 10 SENTENCES NOT SIGNIFICANT FOR
  TALKING
• 10 SENTENCES OR MORE CONSIDERED SIGNIFICANT FOR
  TALKING

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METHODS

• PROSPECTIVE STUDY DONE OF 34 CONSECUTIVE
  SUPERVISED RESIDENT CATARACT SURGICAL CASES
• REPORTED QUANTITY OF UNSOLICITED TALKING BY THE
  PATIENT
• REPORTED COMPLICATIONS AND O.R. TIMES OF CASES
• REPORTED TOPICAL VERSUS RETROBULBAR CASES

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RESULTS

• 4 OF 34 CONSECUTIVE CASES INCLUDED PATIENTS WHO
  TALKED SIGNIFICANTLY DURING THEIR CATARACT
  SURGERY
• SIGNIFICANT TALKING WAS DEFINED AS EQUAL OR
  GREATER THAN 10 LINES OF SPEECH DURING SURGERY
• THERE WAS AN 11.8 INCIDENCE OF SIGNIFICANT
  TALKING BY PATIENTS DURING CATARACT SURGERY

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RESULTS

• 3 OF 4 PATIENTS WHO TALKED SIGNIFICANTLY HAD
  COMPLICATIONS OF VITREOUS LOSS DURING THEIR
  SURGERY (INCIDENCE OF 75 VITREOUS LOSS AMONG
  PATIENTS WHO TALKED)
• ALL 3 PATIENTS WHO TALKED AND HAD VITREOUS LOSS
  UNDERWENT RETROBULBAR ANESTHESIA

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RESULTS

• AVERAGE LENGTH OF O.R. TIME FOR THE 4 CASES WHERE
  PATIENTS TALKED WAS 93 MINUTES
• 75 INCIDENCE OF VITREOUS LOSS IN THESE 4 CASES
• O.R. TIMES OF THESE 4 CASES 73, 80, 55, 165
  MINUTES
• TOPICAL CASES 73 MINUTES
• RETROBULBAR CASES 80, 55, 165 MINUTES
• VITRECTOMY CASES 80, 55, 165 MINUTES

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RESULTS

• VOCAL EMISSIONS BY PATIENTS
• MY NOSE ITCHES
• YOU GUYS MUST BE GOOD NOT TO SHAKE
• VACUUMING?
• DO I GET A CUSTOM LENS?
• SEEING COLORED LIGHTS
• IRRIGATING?.....
• SNAKE CHARMER?
• EXCESSIVE TALKING ABOUT HIMSELF, HIS LIFE,A LOT
  OF QUESTIONS ABOUT THE SURGERY
• WHAT ARE YOU DOING NOW?
• TALKING ABOUT THE DRAFT,TALKING ABOUT THE VIETNAM
  WAR
• ARE WE DONE?
• I CANT MOVE MY ARM
• HEY,DOC?

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CONCLUSIONS

• PATIENTS WHO TALK SIGNIFICANTLY DURING CATARACT
  SURGERY HAD A HIGHER INCIDENCE OF COMPLICATIONS
• 75 VITREOUS LOSS AMONG TALKING PATIENTS
• 20 VITREOUS LOSS AMONG NON-TALKING PATIENTS

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CONCLUSIONS

• PATIENTS WHO TALK EXCESSIVELY DURING CATARACT
  SURGERY HAD PROLONGED SURGICAL TIME
• 93 MINUTES AVERAGE O.R. TIME AMONG TALKING
  PATIENTS
• 58 MINUTES AVERAGE O.R. TIME AMONG NON-TALKING
  PATIENTS

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CONCLUSIONS

• A LARGER PROSPECTIVE STUDY IS UNDERWAY TO
  DETERMINE WHETHER THESE FINDINGS WILL BE
  STATISTICALLY SIGNIFICANT IN A LARGER STUDY

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REFERENCES

• Au Eong KG, Low Ch, Heng WJ, et al. Subjective
  visual experience during phacoemulsification and
  intraocular lens implantation under topical
  anesthesia. Ophthalmology 2000 107284-50.
• Calenda E, Quintyn JC. Analgesia with topical
  anesthesia or with opioids? J Cataract Refract
  Surg 200026792-3.
• Chitkara DK, Smerdon DL. Risk Factors,
  complications, and results in extracapsular
  cataract extraction. J Cataract Refract Surg
  199723570-4.
• Friedman DS, Bass FB, Lubomski LH, et al.
  Synthesis of the literature on the effectiveness
  of regional anesthesia for cataract surgery.
  2001108519-29.
• Lumme P, Laatikainen LT. Risk factors for
  intraoperative and early postoperative
  complications in extracapsular cataract surgery,
  Eur J Ophthalmol 19944151-8.
• Norregaard JC, Bernth-Petersen P, Bellan L, et
  al. Intraoperative clinical practice and risk of
  early complications after cataract extraction in
  the United States, Canada, Denmark, and Spain.
  Ophthalmology 199910642-8.
• Price DD, Bush FM, Long S, Harkins SW. A
  comparison of pain measurement characteristics of
  mechanical visual analogue and simple numerical
  rating scales. Pain 199456217-26.