The choice
There's no right or wrong
selection. In most cases, both
topical and blocks are effec-
tive, and neither is likely to
nudge the other out of exis-
tence in the near future (see
"IV-Free Cataracts" for a
new alternative to topical
and blocks). An ophthalmol-
ogist's choice is likely to be
driven by surgical training,
his comfort level and the
complexity of the procedure.
Surgeons usually opt totally
for one or the other, varying
only when patients and con-
traindications call for it. Both
topical and block anesthesia
have the potential for harm if
patients are allergic to the
anesthetic. Be sure to get a
thorough history regarding
past experience with local
anesthetics.
OSM
Mr. Ruspantine (perryr@ane-
sprof.com) is the clinical com-
pliance manager for Anesthesia
Professionals in Dartmouth,
Mass.
M
A Y 2 0 1 6 • O U T PA T I E N T S U R G E R Y. N E T • 3 5
Topical, block ... or tablet? The bruising and pain
from an IV can be more traumatic than cataract sur-
gery, but now you can skip IV sedation for cataract
cases and instead give patients a new conscious
sedation sublingual tablet called MKO Melt, which
stands for midazolam-ketamine-ondansetron.
Patients place 1 or 2 of the small tablets under
their tongue. MKO Melt typically dissolves within
2-5 minutes. The compound creates a consistent
sedative effect that wears off after a couple hours
and has patients ready for timely discharges, says its
manufacturer, Imprimis Pharmaceuticals.
MKO Melt costs $25 for a 2-troche dose, says
Imprimis, which launched the tablet earlier this year
with the aim of giving ophthalmologists the option to
go IV-free (Imprimis notes that some patients still
may require an IV).
"We've been looking for a way to provide better
sedation in an easier, more cost-effective and
smoother way," says Y. Ralph Chu, MD, founder and
medical director of Chu Vision Institute and Chu
Surgery Center in Bloomington, Minn. — Daniel Cook
SUBLINGUAL SEDATION
IV-Free Cataracts
• UNDER THE TONGUE
The MKO Melt sublingual
tablet dissolves in a
couple minutes and sedates
patients for a couple hours.
Daniel
Cook
