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Retrobulbar Hemodynamics Before and After Retrobulbar-anesthesia

Huber K., Remky A., Arend O.,
RWTH Aachen, Universitätsaugenklinik (Aachen)

Purpose: In this study Color Doppler imaging was performed to investigate the effect of retrobulbar anesthesia on retrobulbar hemodynamics. Furthermore the additive effect epinephrine was examined.
Method: 27 patients (age 73 ± 9,6; 14 f, 13 m) with cataract were included in a prospective study. Color Doppler imaging (Siemens Sonoline Sienna) was used before and directly after retrobulbar anesthesia and after cataract extraction to measure the peak systolic (PSV) and end-diastolic velocities (EDV) in the ophthalmic artery (OA), central retinal artery (CRA) and central retinal vein (CRV). In 12 patients Xylocain 2% without additives (2ml, retrobulbar transconjunctival) and in 15 patients Xylocain 2% with epinephrine 1:200 000 was used.
Results: After retrobulbar anesthesia both groups had a significant reduction of the PSV (OA by 31%, p <0,0001; CRA by 23%, p<0,0001; CRV by 27% p<0,0001) and of the EDV (OA by 20,6%, p<0,0024; CRA by 19 %, p<0,0007; CRV by 27%, p<0,0001). After the operation the flow velocities increased again (PSV: OA by 25%, p<0,0001; CRA by 16%, p<0,0166; CRV by 14% p<0,012 und EDV: OA by 39%, p<0,0001; CRA by 14%, p<0,0007; CRV by 16%, p<0,0074). The eyes without epinephrine supplement had a significant lower reduction (PSV: OA p<0,0013, CRA p<0,0001; EDV: CRV p<0,0353).
Conclusion: Retrobulbar anesthesia induces a tremendous reduction of velocity in the retrobulbar vessels. The supplement epinephrine increases this effect and recovery is much slower. Particularly in patients with disturbed ocular hemodynamics (e.g. Glaucoma) epinephrine should not be used to avoid irreversible functional damage.