AAO 2024: Anesthesia in cataract surgery with the MKO Melt

At the American Academy of Ophthalmology (AAO) meeting in Chicago, Illinois, Brent Kramer, MD, he talked with the Eye Care Network about using the MKO Melt in lieu of IV anesthesia ahead of ocular surgery.

Editor's note: The below transcript has been lightly edited for clarity.

Brent Kramer, MD:

Hey guys, my name is Brent Kramer. I'm an ophthalmologist at Vance Thompson Vision. I practice in Sioux Falls and Alexandria. Today, I'm going to talk a little bit about how we do modern anesthesia with cataract surgery with the MKO Melt, brought to you by ImprimisRx.

So the MKO Melt is a game changer, and three reasons why I think that you should consider implementing it into your practice. One: patient experience. Patients hate needles and they love the slow build anesthesia of the MKO Melt, and so they're not having to wait until they've been prepped, wheeled back to the OR, anxiety building the whole time to get that anesthesia. As soon as they get brought back, they get an MKO Melt, and instead of anxiety building, they become more and more relaxed leading up to the surgery. So patient experience is huge, and that's the primary reason why we love it.

The second reason, the most important part is a patient experience, and driving that is the team experience. So we love that, the experience the team has with the MKO Melt. We don't ask our nurses anymore to do the most painful part of the procedure, which is the IV stick. With the MKO Melt, our nurses are able to focus on building rapport with the patient, getting to know the patient, getting them calm before surgery, answering their questions and all that, and not having to hassle with an IV. It also, you know, doesn't slow our OR down with a tough needle stick or anything like that, pulling the CRNA out for a tough needle stick, all of that stuff.

Third, and I think, you know, a huge reason and a growing reason why we love the MKO Melt, is it's opioid free. It's Versed [midazolam, Roche], ketamine, ondansetron [Zofran, GSK], and we are able to perform cataract surgery without any opioids. Cataract surgery is the most-performed surgery in America, and if ophthalmologists were able to perform it without opioids, that's less fentanyl being made, less fentanyl being diverted and just a better world.

So, MKO Melt and recovery. You know, when you think of...let's start with IV anesthesia, because that's kind of the traditional way of doing anesthesia. You start with a big hit and a high plasma concentration of drug, and then it slowly wears off, and it takes time, versus the MKO Melt is a slower build. You don't get as much of a plasma concentration because you don't need it. And then it's a slow [wear] off. So our patients, you know, we get them in the car, and when they get home, they're not tripping or having difficulty getting back into the house. They have their day with the surgery, they're not, you know, too, too sedated or nauseous for the rest of the day. So that is great.

You know, when I think of the beneficial cases of Melt—and in our surgery center, you know, we do primarily do cataract surgery, but we also do a lot of complex cases—and you'd be surprised how much of those complex cases we're using Melt for. And so for us, you know, cataracts are low hanging fruit in regards to who to start with Melt, but we're doing it for a lot of our endothelial keratoplasty, our standalone MIGs, some of our patients that are anxious, we still start with the Melt, because we love that kind of base form, and then they get an IV for rescue. And I would say about 5% of our patients get an IV going back for surgery, but only 1% of those patients are actually using the IV. So it's pretty rare. In regards to, you know, patients that we don't use Melt for, typically, patients that are getting blocked. So if we're doing a retrobulbar block, they're usually getting a little bit of propofol, getting an IV in, and so then we just use IV anesthesia.