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N. Saraiya, C. Bouchard, A. Khanna; Effects of Intracameral Epinephrine on Heart Rate and Blood Pressure During Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5403.
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Effects of Intracameral epi-"Shugarcaine" on Heart Rate and Blood Pressure during Cataract Surgery
To determine if the injection of intracameral epinephrine/lidocaine (epi-"Shugarcaine") has any statistically significant effect on heart rate or blood pressure during cataract surgery in patients with poor pre-operative dilation or patients at risk for intraoperative floppy iris syndrome (IFIS)
This study is a prospective, observational study and includes 2 categories of patients undergoing cataract surgery: patients with poor pre-operative dilation (< 4 mm pupil) and patients on either terazosin, doxazosin, or tamsulosin who are at risk for IFIS. Patients underwent routine outpatient cataract surgery under monitored anesthesia care with topical/intracameral anesthesia. Baseline readings of blood pressure, heart rate, and EKG were recorded prior to the first incision and prior to the intracameral injection of the epinephrine/lidocaine mixture aka epi-"Shugarcaine". After the injection of the intracameral mixture, the above cardiovascular parameters were recorded immediately during injection (t=0) and then at the following times: t=1 min, t=2 min, t=3 min, t=5 min, t=8 min, t=13 min, and then every five minutes until the end of the case. The timing of injection of intracameral epinephrine was recorded by the anesthesia personnel on the operative record as t=0. Any additional medical interventions (sedatives, anti-hypertensives, etc.) used throughout the procedure were noted.
Thus far with a n=13, analysis of our data using the repeated measures analysis of variance test (with the Tukey multiple comparisons test - TexaSoft, WINKS SDA Software, Sixth Edition, Cedar Hill, Texas, 2007) demonstrates a statistically significant decrease in the systolic blood pressure between time t=1 and t=2 minutes (p=0.03). There was no statistically significant difference in patients’ heart rate and diastolic blood pressure before and after the injection of the epi-"Shugarcaine" mixture. No medical interventions were necessary to treat heart rate or blood pressure intraoperatively in our study population.
Unlikely previously hypothesized, intracameral epi-"Shugarcaine" used during cataract surgery in patients with poorly-dilating or poorly-stabilized pupils does not seem to adversely increase patients’ blood pressure or heart rate. It, therefore, may be safely used to stabilize and dilate the iris without concern that adverse effects on intraoperative cardiovascular parameters will ensue.
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