traditional drug manu-
facturers, it's still a
compounded prod-
uct," says Dr. Berdahl.
He believes that status
is holding some facili-
ties back from adding
this conscious sedation option.
Cost in another barrier. Dr. Berdahl's facility compared the hard
costs of sublingual sedation tablets and IV sedation, and found the
tablets added $1 to $2 to case costs. "The price of the tablets is bun-
dled into the facility fee for cataract surgery," says Dr. Berdahl.
"There's currently no separate billing mechanism."
For eye centers that often operate with razor-thin margins, this
could present a major obstacle. But Dr. Berdahl believes it's short-
sighted to conduct an apples-to-apples cost comparison between the
sedation options. "When we included the soft costs of the time that it
took anesthetists or members of our nursing staff to prep and start
IVs, the troches were actually the less expensive option," says Dr.
Berdahl.
Even if you don't technically come out ahead cost-wise, time and
convenience are two factors to consider. "You definitely save time
with the tablets because you can sedate the patient without having to
find a vein," says Dr. Newsom. "There's no doubt it's a more conven-
ient and easier option."
While FDA status and cost are major obstacles, perhaps the greatest
barrier is simply human nature. "I think one of the biggest factors [to
a lack of widespread adoption] is a resistance to change," says Dr.
Berdahl. "We've grown accustomed to always having IV access and a
lot of anesthesia providers don't feel comfortable without it."
J U L Y 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 5 1
We've grown accustomed to
always having IV access, and a lot
of anesthesia providers don't feel
comfortable without it.
John Berdahl, MD
