Brainstem Anesthesia after Retrobulbar Block: A Case Report and Review of Literature

Tolesa, Kumale; Gebreal, Girum W.

doi:10.4314/ejhs.v26i6.13

Cited by 9 publications

(10 citation statements)

References 32 publications

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“…However, the patient died 4 d later due to cerebral hypoxia and edema. Tolesa et al [ 7 ] reported a patient who regained consciousness and spontaneous breathing after being given oxygen via a mask, intravenous fluids, and an intravenous injection of atropine 1 mg.…”

Section: Discussionmentioning

confidence: 99%

Apnea caused by retrobulbar anesthesia: A case report

Wang¹,

Lan²,

Zou³

et al. 2022

World J Clin Cases

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BACKGROUND Apnea caused by retrobulbar anesthesia is a very rare but severe complication during ophthalmic surgery. CASE SUMMARY We report a rare case of apnea caused by retrobulbar anesthesia, and emergency resuscitation was used. A 74-year-old female patient was diagnosed with rhegmatogenous retinal detachment in the right eye and planned to undergo vitrectomy under retrobulbar anesthesia. After the retrobulbar anesthesia in her right eye, she became unconscious and apneic. It was suggested that she had developed brainstem anesthesia. Assisted ventilation was initiated. Atropine 0.5 mg, epinephrine 1 mg, ephedrine 30 mg, and lipid emulsion were given. Five minutes later, her consciousness and breathing gradually returned, but with uncertain light perception in her right eye. Alprostadil 20 µg was given, and after 2 h her visual acuity resumed to the preoperative level. CONCLUSION Brainstem anesthesia is a serious complication secondary to retrobulbar anesthesia. Medical staff should pay attention to the identification of brainstem anesthesia and be familiar with the emergency treatment for this complication.

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Section: Discussionmentioning

confidence: 99%

Apnea caused by retrobulbar anesthesia: A case report

Wang¹,

Lan²,

Zou³

et al. 2022

World J Clin Cases

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“…1: Technique of giving a peribulbar block more dangerous due to risk of injury to delicate structures as well as much higher risk of globe perforation and life threatening complications such as brainstem anaesthesia. 6,7 Peribulbar anaesthesia is the most preferred route of anaesthesia for MSICS since injecting into the extraconal space is much easier and the risk of complications is much lower compared to retrobulbar anaesthesia. 8,9 However, the peribulbar injection is still more painful during administration.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of subtenon’s anaesthesia with peribulbar anaesthesia for manual small incision cataract surgery in patients with age related cataracts

Bhonsale¹,

Mehta²,

Gandhi³

et al. 2022

IJCEO

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To compare the safety, efficacy and ease of administration of subtenon’s anaesthesia with peribulbar anaesthesia in manual small incision cataract surgery(MSICS) and assess the surgeon and patient comfort. A prospective longitudinal study was conducted among 200 patients undergoing MSICS at a rural tertiary care hospital wherein patients were randomly divided into the two groups of peribulbar (P) and subtenon’s (ST) block. After randomization, 200 patients were assessed for various factors including pain at the time of administration of anaesthetic, time to attain akinesia, patient’s comfort and satisfaction score. 200 eyes of 200 patients who underwent MSCIS were divided into Peribulbar and Subtenon’s group by random number table; of which 122 were women (61%) and 78 were men (39%). There was a significant difference in the amount of anaesthetic used, with the group P (8.37+1.19 ml) usage being more than the group ST(4.02+0.91 ml) (p<0.001). Group P took significantly lesser time to attain akinesia compared to group ST. Group P achieved significantly higher degree of akinesia than group ST. (p<0.001) Significantly greater number of eyes in the group ST required additional anaesthetic injection compared to the group P (p<0.001). A significantly more number of patients experienced pain in the group P. (p=0.008)Significantly greater number of eyes in group ST had mild and moderate chemosis and subconjunctival haemorrhage compared to group P(p<0.001). We found that subtenon’s anaesthesia was an equally effective technique for achieving analgesia and akinesia when compared to peribulbar anaesthesia in patients undergoing MSICS.

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“…Retrobulbar blockade is the traditional choice of regional anesthesia during ophthalmic surgery 13. However, according to the reported data, it has a number of complications, such as retrobulbar hematomas, with an incidence of 0.05%–0.5%, globe perforation and optic nerve injury, which can all lead to irreversible visual loss as well as life-threatening complications manifested by the apnea syndrome 14 15. Furthermore, technical difficulties do exist when performing this block in children, such as anatomical differences, the dynamic alteration in axial length by age, which causes a change from 15 to 23 mm in the first 6 years of life, as well as needle, cannula and local anesthetic dosing problems 16.…”

Section: Discussionmentioning

confidence: 99%

Effect of pterygopalatine blockade on perioperative stress and inflammatory outcomes following paediatric cataract surgery

Oleshchenko

Çok

Юрьева

et al. 2020

Reg Anesth Pain Med

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BackgroundGeneral anesthesia is required to perform pediatric cataract surgery. To reduce severity of surgical intervention and postoperative complications, regional techniques have been concomitantly used. The traditional regional ophthalmic techniques are retrobulbar, peribulbar and sub-Tenon blocks, which present some technical difficulties and associated complication risks. The pterygopalatine blockade has been exempt of many of these concerns as it is performed out of the orbit. The purpose of this study was to compare the analgesic and anti-inflammatory effects of the pterygopalatine blockade with retrobulbar block in children undergoing elective congenital cataract surgery.MethodsAfter approval of ethics committee and informed consents, patients were enrolled to the study to have either ultrasound-guided pterygopalatine block (group P) or retrobulbar block (group R), with 2 mL lidocaine 2% and 1 mL ropivacaine 0.5%. Hemodynamic monitoring was recorded throughout the perioperative period. Cortisol level and oxidation–reduction status were assessed before and after surgery. Pain and inflammatory response (Tyndall effect, corneal syndrome and edema) were assessed on the first postoperative day.ResultsComparative analysis demonstrated a decrease in cortisol of 123.24% (p˂0.05) and an increase in the redox coefficient of 37.7% (p˂0.05) in group P. Pain intensity was significantly higher in group R until the 16th postoperative hour. The corneal syndrome in patients in group P and group R was noted by 7.6% and in 32.1%, respectively (p˂0.05).ConclusionThe use of the pterygopalatine blockade as a component of anesthesia in pediatric cataract surgery allows reduction of the severity of surgical stress during surgical intervention, providing intraoperative hemodynamic stability and prolonged analgesia.

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Brainstem Anesthesia after Retrobulbar Block: A Case Report and Review of Literature

Cited by 9 publications

References 32 publications

Apnea caused by retrobulbar anesthesia: A case report

Apnea caused by retrobulbar anesthesia: A case report

A comparative study of subtenon’s anaesthesia with peribulbar anaesthesia for manual small incision cataract surgery in patients with age related cataracts

Effect of pterygopalatine blockade on perioperative stress and inflammatory outcomes following paediatric cataract surgery

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