Anaesthesia during eye procedures

Typically, procedures performed in a Hospital require some degree of anaesthetic to ensure you have a comfortable and safe experience. The aim of anaesthesia is to ensure you cannot feel any discomfort. Different types of anaesthetics work in different ways.

Ophthalmology procedures are unique in that they require a far less complex sedation process, with some local anaesthetic rather than a full general anaesthetic in the majority of cases. 

Although below we will explain the usual process used for administration of sedation, local blocks and anaesthetics, the patient’s individual needs remain the focus when making decisions about care. The anaesthetic type will be discussed with you by your Ophthalmologist during the initial consultations, and by the anaesthetist, if one is required, on the day of the procedure. Please speak openly to us about your needs.

Local/ topical anaesthetic:

A few eye procedures require “local anaesthesia” where the area the procedure is to be performed on is numbed so nothing is felt. You are awake during the procedure. In this case, there is no medication going into your veins so there is no drowsiness after the procedure. The anaesthetic is applied using eye drops, possibly followed by injection if needed. Don’t worry, the injection won’t be felt after the drops are instilled!

There is no special planning required for local anaesthesia and you can continue to eat and drink as usual before the procedure.

For safety, someone should be available to drive you home. although you will not have been sedated, your eye may be covered, vision blurred or pupil dilated. 

Regional anaesthesia: 

A local nerve block can be added to other types of anaesthetic. This will numb the eye and allow for the Ophthalmologist to control its movement should the specific procedure require it.

Conscious sedation:

For many patients, the prospect of being admitted to a hospital or having a procedure on the eye understandably causes some worry and anxiety. Sedation helps you feel relaxed and comfortable. Conscious sedation is used for most ophthalmic procedures.  Conscious sedation is provided by an Anesthetist and comprises a combination of medicines flowing into your vein through a small drip. Your oxygen, breathing and other signs will be monitored as these may be affected by the anaesthetic medications.  Although you won’t be completely unconscious, you are not as likely to remember the procedure. You may feel some pressure around or the instrument touch your eye, but certainly no discomfort. The mixture of medications is unique to each Doctor and the experience may be different over multiple procedures. 

You will be advised not to eat or drink for about 6 hours before conscious sedation. Although you will not be unconscious, it is important that you are safe and that your stomach is empty to prevent any food or liquid from getting into the lung as all your muscles will relax.  

If you have had sedation, it isn’t safe for you to leave the hospital by yourself or to drive yourself home.

General Anaesthesia:

This is what people most often think of when they hear the word anaesthetic. Very few eye procedures require general anaesthesia. During general anaesthesia, you are unconscious and have no awareness or sensations. Many different medications may be used. Some are gases given through a breathing tube or a mask. Some are given through the drip to induce sleep, relax muscles, and treat pain.

Anaesthetists work with each patient individually to determine which combination of medications is best, depending on your state of health, your medical conditions, the medications you take, any allergies, and the procedure you are having.

Because all your muscles will relax as you go under anaesthesia, it is essential that you do not eat or drink for 8 hours before the procedure time to ensure your stomach is absolutely empty, to prevent the stomach contents from flowing into the lungs.

Serious reactions to general anaesthesia are very rare. Your anaesthetist has immediate access to emergency medications to treat any kind of reaction and will monitor your vital signs continuously throughout surgery and recovery.

The most frequent side effect of general anaesthesia is drowsiness afterwards. This typically goes away within the first hour or two after surgery ends. Some patients may experience a sore throat or nausea. We will ask you about past experiences of side effects as part of the anaesthesia planning. We will do as much as possible to minimise the side effects.

After general anaesthesia, it isn’t safe for you to leave the hospital by yourself or to drive yourself home. Your mental ability may be affected for up to 24 hours. We recommend that you have someone stay with you during that time for your safety.

Unique needs:

In certain cases, health needs unrelated to the procedure may impact the decisions around  the selection of the anaesthetic. These may include the age of the patient (eg: a very young patient), cognitive impairment, physical comfort when lying down, and eye reflexes. We encourage you to let us know of any other aspects you think may be important to your anaesthetic care.

Here are some resources for more information about anaesthetics:

Dr Jones, Bhagwan and Partners https://www.jonesbhagwan.co.za/patient-information 

South African Society of Anaesthesiologists website https://www.sasaweb.com/Home/Home.

Australian Society of Anaesthetists https://asa.org.au/patient-information-pamphlets/

Or make contact with your Ophthalmologist or our team on 0338122020 to discuss your options.