Abstract
Regional anesthesia for ophthalmic surgery has been associated with ischemic complications, such as central retinal vascular occlusion, optic atrophy, and ischemic optic neuropathy. Impairment of pulsatile ocular blood flow (POBF) may occur with regional orbital anesthesia. The authors quantified POBF in patients undergoing regional orbital anesthesia. Eleven patients (12 eyes) with a mean age of 76.5 years having regional orbital anesthesia for cataract or retinal surgery at a private refractive surgical center had POBF monitoring before, during, and 15 minutes after induction of anesthesia. No significant changes in intraocular pressure or heart rate occurred during the induction phase or 15 minutes after induction of regional orbital anesthesia. However, ocular blood flow indices, including pulse amplitude, pulse volume, and POBF, were significantly reduced after attainment of regional orbital blockade (P <.05). With time, recovery occurred in these variables, but they all remained significantly reduced from baseline 15 minutes later. The authors conclude that ocular blood flow appears to be significantly impaired during regional orbital anesthesia. There could be benefit in monitoring POBF to reveal otherwise undetectable deleterious effects on retinal circulation in patients having retrobulbar injections, orbital compression, or digital manipulation of the globe.—Thomas J. Liesegang
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