Systemic effects of intracameral epinephrine during cataract surgery

Aims/Purpose: The objective of this study has been to evaluate the systemic safety that the use of intracameral adrenaline in cataract surgery has on blood pressure and heart rate. This study aims to demonstrate that this procedure is safe for the patient. Methods: A cohort of 777 patients undergoing cataract surgery was studied. Two differentiated groups were prospectively established. Group I with 394 patients included those in whom only mydriatic eye drops were used to achieve adequate operative mydriasis. Group II with 383 patients in whom operative mydriasis was achieved by using the same mydriatic eye drops as in Group I, reinforced by the use of intracameral adrenaline at the beginning of the intervention. The pre‐anaesthetic evaluation was carried out by the anaesthesiology service. Systolic, diastolic and mean blood pressure was monitored non‐invasively at 5‐min intervals from the start of surgery using an automatically inflating cuff. The heart rate was recorded at the beginning of the intervention and every 5 min until the end of the surgery. Oxygen saturation was monitored by digital pulse oximetry. Results: A total of 496 patients presented cardiovascular pathology, being hypertension the most frequent with 417 patients. 65% of the patients with cardiovascular pathology and 54.3% of the hypertense were dilated with intracameral adrenaline, finding no statistically significant differences between being diagnosed with cardiovascular pathology and receiving or not intracameral adrenaline. In all degrees of anaesthetic risk, the number of patients dilated with adrenaline was similar to those dilated with topical mydriatics. There were not significant differences in the variables recorded during surgery between patients treated with intracameral adrenaline and those who were not. Conclusions: We can conclude that intracameral injection of adrenaline at the beginning of cataract surgery did not statistically increase the risk of side effects on blood pressure or heart rate, when compared to the group of patients who only received pre‐operative topical mydriatics. The use of intracameral adrenaline at the start of phacoemulsification does not imply changes in control actions, drug administration or monitoring by the anaesthesia service.