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Klin Monbl Augenheilkd 2015; 232(4): 367-371
DOI: 10.1055/s-0035-1545680
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Update on Regional Anaesthesia in Intraocular Surgery

Regionalanästhesie bei intraokularen Eingriffen
S. Wenger
1   Dept. Anaesthesiology, Inselspital, Bern, Switzerland (Med. Director: Prof. Dr. med. F. Stüber)
,
C. Luyet
2   Dept. Anaesthesiology, Lindenhofspital Bern, Bern, Switzerland
,
J. G. Garweg
3   Berner Augenklinik am Lindenhofspital and University of Bern, Bern, Switzerland
4   Swiss Eye Institute, Rotkreuz, Switzerland
› Author Affiliations
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Publication History

Publication Date:
22 April 2015 (online)

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Abstract

Background: Retrobulbar anaesthesia is a valuable alternative not only for polymorbid and haemodynamically compromised patients. Complications are rare but may be devastating. Methods: Principally, any intraocular surgery can be made under local anaesthesia. There are only a few contraindications to regional anaesthesia such as denial against regional anaesthesia, allergy to local anaesthetics, local infection, severe orthopnea, insufficiently controlled psychiatric disorders or small children and non-cooperative patients. Results: The success rate of retrobulbar anaesthesia in terms of control of intraoperative discomfort approaches 100 % with an intraconal injection in 94 % and a distribution of fluid into the intraconal space in 97 %. Conclusion: Based on the recent literature, the present review compares techniques, describes possible complications and in the absence of evidence-based studies provides suggestions for the handling of patients under thrombocyte aggregation inhibitor and vitamin K antagonist therapy and anticoagulation.

Zusammenfassung

Hintergrund: Die Retrobulbäranästhesie ist eine wertvolle Alternative zur Allgemeinanästhesie nicht nur für polymorbide Patienten. Komplikationen sind selten, aber wenn, dann schwer. Methoden: Grundsätzlich kann jeder intraokulare Eingriff in Retrobulbäranästhesie durchgeführt werden. Zu den wenigen Kontraindikationen gehören die Ablehnung der Patienten, Allergie gegen Lokalanästhetika, lokale Infektionen, Atemnot und nicht sicher kontrollierte psychiatrische Erkrankungen sowie Operationen bei kleinen Kindern und nicht kooperativen Patienten. Ergebnisse: Die Erfolgsrate von Retrobulbäranästhesien bezüglich intraoperativer Beschwerdefreiheit liegt bei annähernd 100 %. Eine intrakonale Injektion ist bei korrekter Technik in 94 % und eine Verteilung der Anästhetica in den intrakonalen Raum in 97 % zu erreichen. Schlussfolgerung: Basierend auf der verfügbaren jüngeren Literatur vergleicht die vorliegende Übersicht die verschiedenen Techniken der periokulären Anästhesie, stellt mögliche Komplikationen und bei Fehlen evidenzbasierter Studien Vorschläge zum Umgang mit Patienten unter Thrombozytenaggregationshemmer-Therapie, Vitamin-K-Antagonisten und Antikoagulation vor.

Schlüsselwörter

Retrobulbär-Anästhesie - Peribulär-Anästhesie - Sicherheit - fibrinolytisch wirksame Medikamente/Fibrinolytika - Thrombozyten-Aggregationshemmer - Methoden zur Nervenblockade

Key words

retrobulbar anesthesia - peribulbar anaesthesia - safety - fibrinolytic agents - thrombocyte aggregation inhibitors - nerve block methods
 

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