Cataracts – PO sedation, no IV, and some BMIs over 50

[hmccarter10]

A surgeon is requesting PO versed for sedation (his order), and no IV for his cataracts. He is also wanting discretion on BMI over 50. Private practice. CRNA only. He is very fast and smooth – approx 6 min cataracts.

The main issue is that a lot of these patients are very poorly managed with a lot of comorbities.

He says he knows other cataract surgeons doing it this way in FL.

What are some ideas for guidelines that we can put into place while also trying to accommodate his requests? How would you handle this situation?

[teddy-byebye]

Florida also has some of the highest anesthesia malpractice claim volumes tied to office-based cases. You don’t want to be the test case where “everyone does it” meets “why wasn’t there IV access?” A fast, smooth 6-minute cataract isn’t the issue. The risk is the combination of:

PO benzodiazepine

No IV access

High BMI (≥50)

Poorly controlled comorbidities

Surgeon-driven sedation decisions

That combo removes your ability to rescue if something predictable happens (airway obstruction, hypoventilation, paradoxical response, hypotension, aspiration, anxiety escalation). If this were me I would not accept BMI ≥50 with PO benzo and no IV. I would accept PO-only sedation in carefully selected low-risk patients. I would insist on written criteria, not case-by-case arguments. I would frame IV access as insurance, not sedation