ONO Anesthesia Guideline

Surgical Indication and Planning

indication

• As soon as surgery is necessary, the procedure, including premedication, must be defined.
• Depends on:
  • Type of procedure
  • surgeon
  • Patient/Morbidity

Coordination with family doctor/ specialist

• During elective surgery, check whether medications (e.g. anticoagulants):
  • stopped or
  • must be bridged
• Consultation with a family doctor or cardiologist, for example

Role of the anesthetist

• Usually only involved on surgery day
• Surgeon/indicative doctor is responsible for:
  • Operational planning
  • premedication
  • Communication with general practitioners/specialists

Need for documents from a family doctor

• patient < 70 years, ASA I—II: usually not necessary
• Patient > 70 years of age or ASA II—III: documents/approval from family doctor makes sense

Clarifications by the family doctor/specialist

If necessary (see above), family doctors will receive a “general practitioner form”

Laboratory at

• coagulation disorders
• known kidney pathology
• known hepatobiliary pathology

ECG at

• ≤ 6 months with a positive cardiac history
• Current ECG for new cases of cardiac disease
• (RX thorax is not necessary)
  

anticoagulation

• Do not discontinue for cataract surgery
• Quick ≥ 70% (INR ≤ 1.2) for retinal (e.g. pars plana vitrectomy) and glaucoma surgery (trabeculectomy, deep sclerectomy), blepharoplasty, entropion, ectropion and ptosis surgery, lacrimal tract surgery
• Quick ≥ 50% (INR ≤ 1.5) for MIGS (including XEN® implantation)

Weight loss drugs

Active substances in the GLP1 agonist group (e.g. Ozempic, Wegovy, Mounjaro) lead to gastric emptying disorders, which significantly increases the risk of aspiration during anesthesia.

• Discontinue medication before general anesthesia or analgosedation
  
  • Weekly injections: 7 days before surgery
  • Daily injections or tablets (e.g. Victoza, Saxenda): 24 before surgery

Communication with the patient

All patients receive the “Information sheet before eye surgery” before surgery

Sober

• Eat up to 6 hours before, nothing after
• Drink only clear up to 2 hours before, nothing more after 2 hours
• Don't smoke

medicines

• Take usual tablets as discussed

escort

• Bring adults home

sanitation

• Remove makeup & mascara
• Remove jewelry
• Emptying the bladder

Emergencies at home

• Severe vomiting, urinary retention, severe pain, fever >39 °C → contact a doctor/clinic immediately