Systemic complications and side effects of retrobulbar anesthesia in risk patients

Abstract

Serious systemic complications with possibly lethal exit after retrobulbar anesthesia have been reported. The present study was performed to evaluate the incidence of complications after anesthesia in risk patients with pre-existing diseases. 2.8% of 3000 cataract operations in our department during October 1991 to April 1993 were performed under general anesthesia, 97.2% under local anesthesia. 1000 anesthesia protocols of these cataract operations under retrobulbar anesthesia and facial block with anesthesia stand-by were analyzed retrospectively. After retrobulbar injection in Atkinson technique we performed a modified O'Brien facial block. The patients were assigned to five different risk groups on the basis of a special point system. The mean age of the patients increased with the risk group from 60.4 years in group 1 to 77.1 years in group 5. Cardiovascular, pulmonary and general risk factors appeared more frequently in the groups of higher risk. The frequency of cardiovascular complications was dependent on affiliation to risk group. The percentual frequency of cardiovascular complications increased from 1.7% in risk group 1 to 7.7% in risk group 5. Decrease of heart rate or blood pressure of more than 30%, or in combination, with the necessity of medical treatment occurred absolutely and relatively most frequently. The frequency of cardiovascular complications amounted 2.2% in the mean. Life-threatening complications with the need of endotracheal intubation or other occurred in 0.1%. The relatively high total frequency of systemic complications of 2.4% is related with age and preexisting diseases. The results underline the necessity of anesthesia stand-by in risk patients with the essential requirements for treatment of typical complications.