Jyh Haur Woo1, Wei Di Ng2, Maaz Mohammad Salah2, Kumari Neelam3, Kah-Guan Au Eong3,4,5, Chandra Mohan Kumar6. 1. Singapore National Eye Centre, Singapore. 2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 3. Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore. 4. Singapore International Eye Cataract Retina Centre, Mount Elizabeth Medical Centre, National University of Singapore, Singapore. 5. Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 6. Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore.
Abstract
INTRODUCTION: Perioperative glycaemic control is an important aspect of clinical management in diabetic patients undergoing cataract surgery under local anaesthesia. While poor long-term glycaemic control has significant implications for surgery, perioperative hypoglycaemia or hyperglycaemia may also compromise patient safety and surgical outcomes. We aimed to survey ophthalmologists and anaesthesiologists on their approach and to identify the prevalent practice patterns in Singapore. METHODS: This was a cross-sectional questionnaire-based survey conducted in four public hospitals in Singapore with established ophthalmology and anaesthesia units. Respondents were approached individually, and the self-administered questionnaires comprised questions related to practice patterns, clinical scenarios and awareness of pre-existing guidelines. RESULTS: A total of 129 doctors responded to the questionnaire survey. 76 (58.9%) were from ophthalmology departments and 53 (41.1%) were from anaesthesia departments. The majority chose to withhold oral hypoglycaemic agents (82.9%) and/or insulin (69.8%), and keep the patient fasted preoperatively. A blood glucose level ≥ 17 mmol/L prompted 86.0%-93.8% of respondents to adopt a treat-and-defer strategy, while a level ≥ 23 mmol/L prompted 86.0%-96.9% of respondents to cancel the cataract surgery. The respondents were consistently more concerned about perioperative hyperglycaemia (n = 99, 76.7%) than intraoperative hypoglycaemia (n = 83, 64.3%). CONCLUSION: The current study presented the prevalent practice patterns of ophthalmologists and anaesthesiologists in the perioperative management of diabetic patients undergoing cataract surgery in four public hospitals in Singapore. Further research in this field is required, and may be useful for the future formulation of formal guidelines and protocols.
INTRODUCTION: Perioperative glycaemic control is an important aspect of clinical management in diabeticpatients undergoing cataract surgery under local anaesthesia. While poor long-term glycaemic control has significant implications for surgery, perioperative hypoglycaemia or hyperglycaemia may also compromise patient safety and surgical outcomes. We aimed to survey ophthalmologists and anaesthesiologists on their approach and to identify the prevalent practice patterns in Singapore. METHODS: This was a cross-sectional questionnaire-based survey conducted in four public hospitals in Singapore with established ophthalmology and anaesthesia units. Respondents were approached individually, and the self-administered questionnaires comprised questions related to practice patterns, clinical scenarios and awareness of pre-existing guidelines. RESULTS: A total of 129 doctors responded to the questionnaire survey. 76 (58.9%) were from ophthalmology departments and 53 (41.1%) were from anaesthesia departments. The majority chose to withhold oral hypoglycaemic agents (82.9%) and/or insulin (69.8%), and keep the patient fasted preoperatively. A blood glucose level ≥ 17 mmol/L prompted 86.0%-93.8% of respondents to adopt a treat-and-defer strategy, while a level ≥ 23 mmol/L prompted 86.0%-96.9% of respondents to cancel the cataract surgery. The respondents were consistently more concerned about perioperative hyperglycaemia (n = 99, 76.7%) than intraoperative hypoglycaemia (n = 83, 64.3%). CONCLUSION: The current study presented the prevalent practice patterns of ophthalmologists and anaesthesiologists in the perioperative management of diabeticpatients undergoing cataract surgery in four public hospitals in Singapore. Further research in this field is required, and may be useful for the future formulation of formal guidelines and protocols.
Authors: Gary C Brown; Melissa M Brown; Alicia Menezes; Brandon G Busbee; Heidi B Lieske; Philip A Lieske Journal: Ophthalmology Date: 2013-12 Impact factor: 12.079