To the Editor:—

I thoroughly enjoyed the review by Vann et al.  1of anesthesia for ophthalmology. However, I was surprised by their quotation from Pecka and Dexter.2: “These authors commented that there is ‘no  justification to decreasing the amount of time that anesthesiologist or nurse anesthetists spend caring for patients undergoing cataract extraction with a retrobulbar block’” (italics added).

The full paragraph is as follows:

In conclusion, [in 1995] at our tertiary medical center, anesthesia providers [did] interventions after placement of the retrobulbar block for 33% of cases (upper bound < 36%). Therefore, a retrospective study cannot determine whether, to decrease costs, a registered nurse could safely replace the anesthesia provider after uneventful placement of a retrobulbar block. A prospective study assessing patient outcome related to these interventions is required for a more meaningful assessment of present standards for monitored anesthesia care for cataract extractions … There is currently  no justification to decreasing the amount of time that anesthesiologists or certified registered nurse anesthetists spend caring for patients undergoing cataract extraction with a retrobulbar block.

The word currently  is important.

The University of Iowa, Iowa City, Iowa. franklin-dexter@uiowa.edu

References

1.
Vann MA, Ogunnaike BO, Joshi GP: Sedation and anesthesia care for ophthalmologic surgery during local/regional anesthesia. Anesthesiology 2007; 107:502–8
2.
Pecka SL, Dexter F: Anesthesia providers’ interventions during cataract extraction under monitored anesthesia care. AANA J 1997; 65:357–60