A Case of Brainstem Anesthesia after Retrobulbar Block for Globe Rupture Repair

Author:

Nanda Tavish12ORCID,Ross Lisa3,Kerr Gregory3

Affiliation:

1. Department of Ophthalmology, NYC Health+Hospitals/Harlem, New York, NY, USA

2. Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA

3. Department of Anesthesia, NYC Health + Hospitals/Harlem, New York, NY, USA

Abstract

Purpose. To present a rare case of brainstem anesthesia from retrobulbar block and discuss evidence-based methods for reducing the incidence of this complication. Case. A 72-year-old female, was given a retrobulbar block of 5 mL of bupivacaine 0.5% for postoperative pain management, after a globe rupture repair under general anesthesia. Prior to injection, the patient was breathing spontaneously via the anesthesia machine circuit and had not received any additional narcotics/muscle relaxants for 2.5 hr (with full recovery of neuromuscular blocking agent after anesthetic reversal). Over 7 min, however, there was a steady increase in ETCO2 and the patient became apneic, consistent with brainstem anesthesia. She remained intubated and was transported to the postanesthesia care unit for prolonged monitoring, with eventual extubation. Discussion. Brainstem anesthesia is an important complication to recognize as it can lead to apnea and death. The judicious use of anesthetic volume, shorter needle tips, and mixed formulations can help reduce the chance of brainstem anesthesia. Observation of the contralateral eye 5–10 minutes after injection for pupillary dilation, and prior to surgical draping, can help identify early CNS involvement.

Publisher

Hindawi Limited

Subject

Anesthesiology and Pain Medicine

Cited by 3 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Vestibular Symptoms Following a Retrobulbar Block: A Case Report;A&A Practice;2024-01

2. Brainstem Anesthesia after Retrobulbar Anesthesia in Cataract Surgery: A Case Report;European Journal of Medical and Health Sciences;2023-07-26

3. Bupivacaine;Reactions Weekly;2022-10-08

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