[Atkinson's retrobulbar anesthesia. A quality control study]

Recognized local and systemic complications of retrobulbar anaesthesia (RA) are well known. The purpose of this study was to determine which clinical signs predict the success of the RA technique.

We prospectively investigated 500 consecutive patients scheduled for elective eye surgery for cataracts and for vitreoretinal procedures. Anaesthesia was administered using the Atkinson RA technique while for preoperative quality control, the following parameters were recorded: chemosis, eye motility, preservation of vision, active eyelid movement, and burning caused by disinfection. For analysis, a multidimensional model designed to be useful for forecasting results of the anaesthetic outcome was used. The RA was labeled as a "success" when no supplementary anaesthetics were required. "Partial success" was defined as an incomplete RA with supplementary subconjunctival anaesthetic requirement or an anaesthetic given in the form of eyedrops. In the case of "RA failure", the RA had to be repeated.

The success rate for RA was higher for cataract operations than for glaucoma operations. The success rate was not associated with the choice of the local anaesthetic, the application of ocular, compression, or the anaesthetists and surgeons who performed the RA. Burning caused by disinfectant, lid opening and temporal eye motility were found not to be associated with a successful outcome. The presence of chemosis had no influence on the success of anaesthesia.

The results of this study demonstrated that prognostic factors such as defined existing clinical signs, are early predictors of the success of the Atkinson RA.