Challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices

Joanna Mary Jefferis,1–3 Michael Patrick Clarke,1,3 John-Paul Taylor,2 Katie Rhian Brittain4 1Newcastle Eye Centre, Royal Victoria Infirmary, 2Institute for Ageing and Health, 3Institute of Neurosciences, 4Institute of Health and Society, Newcastle University, Newcastle upon Tyn...

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Autores principales:	Jefferis JM, Clarke MP, Taylor JP, Brittain KR
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/3881ae2cba5148fbb68bc8236797cfa1
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spelling	oai:doaj.org-article:3881ae2cba5148fbb68bc8236797cfa12021-12-02T06:11:04ZChallenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices1177-5483https://doaj.org/article/3881ae2cba5148fbb68bc8236797cfa12014-09-01T00:00:00Zhttp://www.dovepress.com/challenges-for-the-cataract-surgeon-treating-people-with-dementia-a-qu-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483 Joanna Mary Jefferis,1–3 Michael Patrick Clarke,1,3 John-Paul Taylor,2 Katie Rhian Brittain4 1Newcastle Eye Centre, Royal Victoria Infirmary, 2Institute for Ageing and Health, 3Institute of Neurosciences, 4Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK Background: In light of the growing number of people with dementia and age-related cataract, as well as changing anesthetic practices for cataract surgery, this study aimed to explore the experiences of cataract surgeons in managing patients with dementia and making anesthetic decisions.Methods: This was a qualitative study using semistructured interviews with senior cataract surgeons from two centers in England. Fourteen surgeons were interviewed, and a thematic approach informed by grounded theory was used for the analysis.Results: Choice of anesthesia for people with dementia was a central theme arising from the data. Surgeons varied in their thresholds for using general anesthesia. Decisions about suitability for local anesthesia were limited by time constraints and generally made rapidly and based on instinct; dementia was not always apparent at the point of preassessment. Surgeons used a variety of topical, sub-Tenon’s, and sharp needle blocks for people with dementia. Surgeons discussed techniques to help patients tolerate local anesthesia, such as clear communication, a primary nurse, hand-holding, and support from an anesthetist. However, within our sample, some surgeons had had negative experiences of operating on people with dementia, where an incorrect judgment had been made that they could tolerate local anesthetic cataract surgery. Conclusion: This study highlights the differing practices of cataract surgeons when making anesthetic choices for people with dementia and the challenges they face. In order to avoid the situation of a patient with dementia becoming distressed during awake surgery, increased time at preassessment and anesthetic support may be beneficial. Keywords: dementia, cataract extraction, anesthesiology, qualitative researchJefferis JMClarke MPTaylor JPBrittain KRDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2014, Iss default, Pp 1993-1999 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Jefferis JM Clarke MP Taylor JP Brittain KR Challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices
description	Joanna Mary Jefferis,1–3 Michael Patrick Clarke,1,3 John-Paul Taylor,2 Katie Rhian Brittain4 1Newcastle Eye Centre, Royal Victoria Infirmary, 2Institute for Ageing and Health, 3Institute of Neurosciences, 4Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK Background: In light of the growing number of people with dementia and age-related cataract, as well as changing anesthetic practices for cataract surgery, this study aimed to explore the experiences of cataract surgeons in managing patients with dementia and making anesthetic decisions.Methods: This was a qualitative study using semistructured interviews with senior cataract surgeons from two centers in England. Fourteen surgeons were interviewed, and a thematic approach informed by grounded theory was used for the analysis.Results: Choice of anesthesia for people with dementia was a central theme arising from the data. Surgeons varied in their thresholds for using general anesthesia. Decisions about suitability for local anesthesia were limited by time constraints and generally made rapidly and based on instinct; dementia was not always apparent at the point of preassessment. Surgeons used a variety of topical, sub-Tenon’s, and sharp needle blocks for people with dementia. Surgeons discussed techniques to help patients tolerate local anesthesia, such as clear communication, a primary nurse, hand-holding, and support from an anesthetist. However, within our sample, some surgeons had had negative experiences of operating on people with dementia, where an incorrect judgment had been made that they could tolerate local anesthetic cataract surgery. Conclusion: This study highlights the differing practices of cataract surgeons when making anesthetic choices for people with dementia and the challenges they face. In order to avoid the situation of a patient with dementia becoming distressed during awake surgery, increased time at preassessment and anesthetic support may be beneficial. Keywords: dementia, cataract extraction, anesthesiology, qualitative research
format	article
author	Jefferis JM Clarke MP Taylor JP Brittain KR
author_facet	Jefferis JM Clarke MP Taylor JP Brittain KR
author_sort	Jefferis JM
title	Challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices
title_short	Challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices
title_full	Challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices
title_fullStr	Challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices
title_full_unstemmed	Challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices
title_sort	challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/3881ae2cba5148fbb68bc8236797cfa1
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Challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices

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