Phacoemulsification With Intraocular Lens Implantation Medication

Updated: Mar 15, 2016
  • Author: Manolette R Roque, MD, MBA, FPAO; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

Medication Summary

Topical and general anesthesia may be used to promote patient comfort during the procedure. Topical anesthesia consists of analgesia. It blocks the production and not the transmission of pain sensation. Light sedatives and anxiolytics may also be given to facilitate patient comfort and relaxation.

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Local Anesthetics, Esters

Class Summary

These agents are used in procedures where rapid and short-acting topical ophthalmic anesthetics are required.

Proparacaine (Alcaine, Parcaine)

Has rapid onset of anesthesia that begins within 13-30 sec after instillation. However, has short duration of action of about 15-20 min.

Since prolonged eye anesthesia can eliminate patient's awareness of mechanical damage to, cornea, should not be used outside of the emergency department. Frequent use of anesthetics may retard healing.

Of all topical anesthetics, this is least irritating. Prevents initiation and transmission of impulse at nerve cell membrane by stabilizing and decreasing ion permeability.

Onset of action takes place within 20 sec of application.

Anesthetic effect may last up to 10-15 min.

Tetracaine (Altacaine, TetraVisc, Tetcaine)

By decreasing neuronal membrane's permeability to sodium ions, this agent blocks both initiation and conduction of nerve impulses. Results are inhibition of depolarization, which blocks the conduction of the impulse.

Available in solution and ointment. Onset of action takes place within 30 seconds of application and anesthetic effect may last up to 15-20 min.

Medication stings considerably on application.

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Local Anesthetics, Amides

Class Summary

These agents are used in procedures where rapid and long-acting topical ophthalmic anesthetics are required. The author prefers to supplement topical proparacaine with preservative-free lidocaine 1% intracameral injection. Intracameral anaesthesia has been proven safe for intraocular structures, although its necessity remains controversial.

Lidocaine (Akten)

Decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses.

Bupivacaine

Decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses.

Ropivacaine (Naropin)

Decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses.

Mepivacaine (Polocaine MPF)

Prevents the generation and conduction of nerve impulses.

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Anxiolytics, Benzodiazepines

Class Summary

These agents are used for their anti-convulsive effects to prevent or treat the convulsions of any origin (e.g. toxicity from the anesthetic agents).

Diazepam (Valium, Diastat)

Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing the activity of GABA.

Individualize the dosage and increase it cautiously to avoid adverse effects.

Midazolam (Versed)

Shorter-acting benzodiazepine sedative-hypnotic useful in patients requiring acute and/or short-term sedation. Midazolam is also useful for its amnestic effects.

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