Peribulbar anesthesia (PB) is known to be safer than retrobulbar (RB) anesthesia. To our knowledge, no amaurosis has been described after PB. We report here the cases of two patients who underwent PB before membrane peeling. The injections were administered with a 25-gauge, 22-mm bevel disposable needle. The anesthetic used was ropivacaine 1% with a volume of 8 ml and 75 µg of clonidine as an adjuvant (7.5 µg/ml). Given that complete akinesia was not achieved, a second injection of 2 ml was administered in the supero-medial injection site. Thirty minutes after the PB, the first patient experienced amaurosis with no light perception (LP). The ophthalmic examination was normal. Visual acuity recovered after 1 day. Regarding the second patient, the loss of VA was observed 20 min after the PB. IOP was 20 mmHg. The anterior segment and fundus exam were normal. Rubin found the PB technique to be as effective and safer than RB injection, as the needles are not supposed to enter the RB space and Davis and Mandel found no amaurosis after PB. PB is administered via the extraconal injection of an anesthetic agent. These amaurosis might be explained by the fact that some anesthetic may have penetrated the RB space. In cases where two PB injections are administered, the anatomy is expected to change due to the volume effect of the first injection. The second injection is higher risk as it is administered closer to the optic nerve.

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Background Members of anesthesia teams are involved in the management of COVID-19 infection cases at many stages particularly during acute airway interventions. Here, we describe a series of airway procedures to manage complex post-COVID-19 tracheomalacia in a high-risk patient. Case presentation A 67-year-old female with a medical history of diabetes mellitus, hypertension, and morbid obesity and recent COVID-19 infection requiring prolonged intubation presented to our hospital in severe respiratory distress. She was found to have long-segment tracheomalacia requiring multiple airway surgical procedures and stenting. During her hospital stay, she suffered multiple cardiac arrests due to respiratory failure and was not stabilized until airway tailored custom stent was inserted. She was later discharged with no significant long-term sequel. Conclusions It is important for the anesthesia staff, as part of the airway management plan team, to recognize the exact location and the anatomy of tracheomalacia. Certain anatomical deviations could affect our usual airway management pathways. Failure to do that can lead either to airway obstructions or detrimental hypoxia.