Colour Doppler imaging before and after retrobulbar anaesthesia in patients undergoing cataract surgery.
OBJECTIVE
To investigate the effect of retrobulbar anaesthesia on retrobulbar haemodynamics, colour Doppler imaging was performed. Furthermore, the additive effect of epinephrine was examined.


METHODS
Forty-one patients (age 72.7+/-8.9; 22 f, 19 m) undergoing planned cataract surgery were included in a prospective study. Colour Doppler imaging was performed before and directly after retrobulbar anaesthesia and after cataract surgery to measure the peak systolic velocity (PSV) and end-diastolic velocity (EDV) in the ophthalmic artery, central retinal artery and central retinal vein. In 18 patients lidocaine 2% without additives (2 ml, retrobulbar transconjunctival injection) and in 23 patients lidocaine 2% with epinephrine 1:200,000 was used.


RESULTS
After retrobulbar anaesthesia both groups had a significant reduction of the PSV and of the EDV. After surgery flow velocities increased again. The addition of epinephrine resulted in a significantly greater reduction and slower recovery of flow velocities.


CONCLUSIONS
Retrobulbar anaesthesia induces a marked reduction of velocity in the retrobulbar vessels. The supplement epinephrine increases this effect, and recovery is much slower. Thus, particularly in patients with already disturbed ocular haemodynamics epinephrine should not be used in order to avoid irreversible functional damage.
Huber
K K
KK
Department of Ophthalmology, Medical Faculty of Aachen University, University Hospital Aachen, Aachen, Germany. KHuber@ukaachen.de
Remky
A
A
D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D001783:Blood Flow Velocity / Q000502:physiology; D002387:Cataract Extraction; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging / Q000502:physiology*; D009915:Orbit; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D012161:Retinal Artery / Q000000981:diagnostic imaging / Q000502:physiology*; D012169:Retinal Vein / Q000000981:diagnostic imaging / Q000502:physiology*; D016683:Supine Position; D018615:Ultrasonography, Doppler, Color; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004837:Epinephrine