COST Anesthesia and Medications in Ophthalmic Surgery Flashcards

A patient undergoing cataract surgery under monitored anesthesia care (MAC) suddenly becomes confused and agitated. What is the most likely cause?

Answer: Paradoxical reaction to benzodiazepines or oversedation

Paradoxical excitation from benzodiazepines or hypoxia/hypercapnia from oversedation can cause agitation and confusion in patients under MAC during ophthalmic procedures.

Which antibiotic is most commonly used as intracameral prophylaxis against endophthalmitis at the close of cataract surgery in the United States?

Answer: Moxifloxacin

Intracameral moxifloxacin has become widely adopted in US practice for endophthalmitis prophylaxis due to its broad-spectrum coverage and favorable safety profile.

Triamcinolone acetonide is injected intravitreally or subconjunctivally in ophthalmic surgery primarily as which type of agent?

Answer: Corticosteroid anti-inflammatory

Triamcinolone acetonide is a long-acting corticosteroid used to reduce intraocular inflammation, treat macular edema, and visualize vitreous during vitreoretinal surgery.

Which ocular hypotensive agent class lowers IOP by increasing uveoscleral outflow of aqueous humor?

Answer: Prostaglandin analogs

Prostaglandin analogs (e.g., latanoprost, bimatoprost) lower IOP primarily by enhancing uveoscleral (unconventional) outflow and are the most potent topical IOP-lowering agents.

Preoperative NSAIDs (non-steroidal anti-inflammatory drops) are used before cataract surgery primarily to:

Answer: Prevent intraoperative miosis and reduce postoperative inflammation

Topical NSAIDs inhibit prostaglandin synthesis, helping maintain pupil dilation (preventing miosis) during phacoemulsification and reducing postoperative inflammation and CME risk.

Which reversal agent is used to antagonize opioid-induced respiratory depression in the perioperative setting?

Answer: Naloxone

Naloxone is a competitive opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression, sedation, and analgesia in the perioperative period.