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M. Jaeger, S. Bender, T. Hemmerling, J.B. Jonas; Patient Controlled Sedation (PCS) with Retrobulbar Catheter Anaesthesia in Ophthalmic Surgery . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3026.
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Purpose: To evaluate prospectively ophthalmic surgery during local anaesthesia with use of a retrobulbar catheter and patient controlled sedation. Methods: Eight patients underwent nine vitreoretinal surgeries with local anesthesia. They received initially a retrobulbar bolus of 6 to 8ml of local anesthetics (mepivacaine 2%, ropivacaine 0.75% or bupivacaine 0.5%). Additionally, a temporary catheter was introduced into the retrobulbar space for the possibility of repeated re-injections. Preoperatively, additional premedication was not administered. At the start of surgery, all patients received intravenously propofol in a dosage of 0.3 mg per kg body weight. The patients had a button in their hands to trigger propofol injections themselves if they wanted to be relaxed. Bispectral-index (BIS) was used to record the depth of sedation. If pain occurred, re-injections through the retrobulbar catheter were performed. Results: Mean duration of surgery was 80.6 ± 44.5 minutes (range, 45 to 155 minutes). Two patients triggered propofol re-injections, while one patient began in the 85th minute to trigger five re-injections. Intraoperatively two patients needed re-injections through the retrobulbar catheter. If an additional ophthalmic surgery had to be performed, 7 out of 8 patients would prefer this type of local anaesthesia with a retrobulbar catheter and patient controlled sedation. Conclusions: Retrobulbar catheter anesthesia with patient controlled sedation may be an additional option in the armamentarium of anesthesia for ophthalmic surgery.
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