patients by giving them 1 to 2 sublingual tablets containing midazo-
lam, ketamine and an antiemetic. Ms. Dillon's staff and surgeons tri-
aled the tablets, but decided against using them. "Sometimes 1 tablet
wasn't enough, and 2 were too many," says Ms. Dillon. "We found that
it took patients longer than the typical 10 to 15 minutes to recover
after surgery."
The bigger issue is that the tablets are controlled substances that
need to be refrigerated. "We had to figure out a way to double-lock
the medications in a refrigerator," says Ms. Dillon, who ended up
storing the tablets in a small safe placed in a refrigerator, which had
French handles she could secure with a bike lock. "Those are things
you don't think about."
• Pupil maintenance. Roughly two-thirds (63%) of respondents say
their surgeons use mechanical devices — Malyugin rings and iris
hooks, for example — in less than 5% of cataract cases to maintain
pupil size in patients who are difficult to dilate. The survey also
shows that 45% of respondents say their surgeons use pharmaceuti-
cal pupillary dilations methods in less than 5% of cataract cases.
However, one-third say their surgeons use the drugs in more than
20% of cases.
Ms. Dillon's surgeons trialed a pupillary dilation medication, but
found it wasn't overly helpful and was also cost-prohibitive, even
though her facility could apply for reimbursement. "If I'm paying $460
per case and waiting to be reimbursed, surgeons will see their divi-
dends dwindle until that reimbursement comes back," says Ms. Dillon.
Pharmaceutical options for keeping pupils dilated were too expensive
for the ASC of Niagara, says Ms. Zimdahl, so surgeons there now choose
between epi-Shugarcaine ($26 per case), Malyugin rings and iris retrac-
tors ($100-plus per case).
• Improved refractive outcomes. Promising patients that their
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