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Myocardial Reinfarction following Local Anesthesia for Ophthalmic Surgery

Carl L. Backer, BA^*, John H. Tinker, MD, Dennis M. Robertson, MD, and Ronald E. Vlietstra, MB, ChB

*Medical Student. Departments of Anesthesiology, Ophthalmology, and Internal Medicine (Cardiovascular Disease Division), Mayo Clinic and Mayo Medical School, Rochester, Minnesota 55901. Associate Professor of Anesthesiology. Departments of Anesthesiology, Ophthalmology, and Internal Medicine (Cardiovascular Disease Division), Mayo Clinic and Mayo Medical School, Rochester, Minnesota 55901. Associate Professor of Ophthalmology Departments of Anesthesiology, Ophthalmology, and Internal Medicine (Cardiovascular Disease Division), Mayo Clinic and Mayo Medical School, Rochester, Minnesota 55901. Assistant Professor of Medicine. Departments of Anesthesiology, Ophthalmology, and Internal Medicine (Cardiovascular Disease Division), Mayo Clinic and Mayo Medical School, Rochester, Minnesota 55901.

Abstract

During the years 1962 through 1977, more than 10,000 ophthalmic operations at our institution were managed with local anesthesia and/or retrobulbar block. Of these, 195 patients who underwent 288 separate operations had previously suffered a documented myocardial infarction (MI). Not a single postoperative reinfarction or death occurred in this group. During the same period, only 26 such operations were performed on 21 patients with prior MI under general anesthesia. This much smaller group also suffered no perioperative reinfarctions. This zero percent reinfarction rate is significantly less than the 6.1% reinfarction rate previously reported from this institution for 587 operations on patients with documented preoperative Ml who had general or major regional anesthesia for nonophthalmic surgery. In the prior study, intrathoracic, upper abdominal, and great vessel operations, lasting 3 hours or more, were associated with significantly greater reinfarction rates than the total population. Eliminating these from the prior series yields a 3.6% reinfarction rate for all other operations, which is still significantly greater than the zero reinfarction in the present series of ophthalmic procedures. The group that had general anesthesia for ophthalmic surgery is too small for meaningful comparisons, and we cannot conclude that local is safer than general anesthesia. We do conclude that local anesthesia and/or retrobulbar block for ophthalmic surgery does not pose special risks for reinfarction in the patient with a preoperative MI.

Key Words: HEART: infarction • ANESTHESIA: ophthalmologic • SURGERY: ophthalmologic.

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