Archive Anesthesia 2019

Should You Go IV-Free?

Oral sedation promises to improve efficiencies and increase patient satisfaction in busy eye centers.

Daniel Cook

Daniel Cook, Executive Editor


Michael Greenwood, MD
GOOD BEGINNING Patients appreciate avoiding IV starts, perhaps the most stress-inducing part of surgery.

The refractive eye procedure was scheduled to begin in about 20 minutes, just enough time for the sedative effects of the sublingual tablets to take effect. Michael Greenwood, MD, looked on as a nurse opened a two-pack of tablets. Things got a little hazy after that. “I vaguely recall someone in the OR telling a joke and another person in the room saying the procedure went perfectly,” remembers Dr. Greenwood, an ophthalmic surgeon at Vance Thompson Vision in Fargo, N.D.

Dr. Greenwood was the one sitting in the stretcher chair, not standing next to it, when the nurse slid 2 tablets under his tongue. The tablets slowly dissolved, sending a steady stream of the sedative midazolam, the analgesic ketamine and the antiemetic ondansetron into his bloodstream. The worry of surgery slipped away in minutes, and he soon become blissfully unaware of his surroundings.

“The entire experience was very pleasant,” he says. So pleasant, in fact, that he chose oral sedation for subsequent surgeries performed on his wife and mother-in-law.

Proponents of IV-free eye surgery tout its potential to please patients and improve clinical workflows, while others point to cost and safety concerns as reasons to stick with intravenous sedation. Here’s a look at both sides.

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