We thank Drs. Dexter and Bourke for their comments on our article.1First, in response to Dr. Dexter, we believe that we maintained the meaning of the quotation from his article2that anesthesia care is justified during eye surgery performed under retrobulbar block  (italics added). The administration of a retrobulbar block has not changed in the years since his article was written; therefore, the word currently  does not change our sentiment.

Second, in reply to Dr. Bourke, we appreciate his concerns about topical anesthesia and emphasize in our article that the best technique for local/regional anesthesia considers the surgeon’s skill and anesthesiologist’s comfort as well as patient needs. Regarding the conversion of a phaco procedure during topical anesthesia to vitreoretinal surgery, we note that these procedures can be conducted under a sub-Tenon block that the surgeon can administer to the topicalized eye on the surgical field. As far as his concerns about sedation, we covered sedation techniques and outcomes in the article, also noting that patient expectations as well as demographic and regional differences often account for choice of sedation during a block. We appreciate his use of alternative techniques such as transcutaneous electrical stimulation. However, use of transcutaneous electrical stimulation as an alternative to sedation techniques needs to be formally evaluated before it can be recommended for routine use.

*University of Texas Southwestern Medical Center, Dallas, Texas. girish.joshi@utsouthwestern.edu

Vann MA, Ogunnaike BO, Joshi GP: Sedation and anesthesia care for ophthalmologic surgery during local/regional anesthesia. Anesthesiology 2007; 107:502–8
Pecka SL, Dexter F: Anesthesia providers’ interventions during cataract extraction under monitored anesthesia care. AANA J 1997; 65:357–60