Grand Mal Seizures after Retrobulbar Block

Meyers, Elsie F.; Ramirez, Rebecca C.; Boniuk, Isaac

doi:10.1097/00132586-197908000-00054

Cited by 6 publications

(9 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14 This mechanism has been suggested in cases in which immediate grand mal seizure activity has been observed during retrobulbar injection. 15 If unintentional intra-arterial injection was the probable mechanism in our case, convulsions should have occurred within seconds rather than minutes.…”

Section: Discussionmentioning

confidence: 75%

Delayed Convulsions and Brief Contralateral Hemiparesis After Retrobulbar Block

Pragt

Zundert

Kumar

2006

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

Objective: This case report describes convulsions and hemiparesis after retrobulbar injection with good outcome in a patient undergoing outpatient cryocoagulation of his right eye.Case Report: We report a young man in which localized convulsions of the ipsilateral face occurred 9 minutes after retrobulbar injection followed shortly by convulsions of the contralateral arm and leg. After the convulsions, the patient experienced left-sided hemiparesis resolving approximately 1 hour after the injection. There was no hemodynamic instability during this period. It was difficult to determine the exact cause of convulsions and hemiparesis. Conclusions:We believe these complications occurred because of unintentional injection of local anesthetic agent into the subarachnoid space without affecting the brainstem. Possible mechanisms of spread of local anesthetic agent into the central nervous system after retrobulbar block are discussed. Reg L ocal anesthesia for major ophthalmic surgical procedures includes peribulbar, retrobulbar, and sub-Tenon's block, 1-3 but the exact frequency of their use is not known. Although the classical retrobulbar technique 4 is still in use, the technique has evolved over the years. In current or modern retrobulbar block, a needle Յ32 mm long is inserted through the extreme inferolateral quadrant just below the lateral rectus muscle. 5 Despite its careful use, sight and/or life-threatening complications have occurred. 6-8 Numerous case reports of apnea, respiratory difficulties, cardiovascular collapse, convulsions, and paralysis of 1 or more limbs have been reported after local anesthetic spread to unusual neurologic locations. 9 The exact mechanism of spread is not fully understood in most cases. A variety of signs and symptoms after injection of local anesthetic agent into the optic nerve sheath have been reported. 9 A case of contralateral hemiparesis was reported after retrobulbar block in addition to which the patient developed bilateral ophthalmoplegia and loss of consciousness for approximately 2 hours. 10 We present a case in which localized ipsilateral convulsions occurred 9 minutes after retrobulbar injection, and this was followed shortly by convulsions in the contralateral arm and leg. Contralateral hemiparesis occurred, but the patient recovered full muscle power within an hour. To our knowledge, delayed convulsions and contralateral hemiparesis after retrobulbar block have not been reported. Case ReportA 36-year-old man (height 1.73 m, weight 80 kg, and American Society of Anesthesiologists 2) was scheduled for outpatient cryocoagulation of his right eye. The medical history included congenital blindness in the right eye and non-Hodgkin's lymphoma with leptomeningeal metastasis. He received intrathecal chemotherapy and skull radiotherapy more than 5 years before. Although his medical conditions remained stable, he developed radiation retinitis in both eyes. He was addicted to nicotine and

show abstract

Section: Discussionmentioning

confidence: 75%

Delayed Convulsions and Brief Contralateral Hemiparesis After Retrobulbar Block

Pragt

Zundert

Kumar

2006

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

show abstract

“…However, the clinical picture resulting from intra-arterial injection is the immediate onset of grand mal seizure activity as the predominant sign. 16 The absence of grand mal seizure activity does not exclude the second mechanism described above as direct deposition of local anaesthetic to the brain structures after inadvertent intra-arterial injection could induce electrical silence without grand mal seizure activity, is…”

Section: Discussionmentioning

confidence: 99%

Brainstem anaesthesia after peribulbar anaesthesia

1997

View full text Add to dashboard Cite

Purpose: -lb present a case of brainstem anaesthesia as a complication of peribulbar anaesthesia.Clinical features: A 75-yr-old woman received peribulbar anaesthesia for cataract surgery. A few seconds after the block was performed, she had a respiratory arrest, became unconscious, and developed hypertension and tachycardia followed by hypotension and bradycardia, Ventilatory and haemodynamic support were performed before the patient regained adequate spontaneous breathing, and normal heart rate and blood pressure. Conclusion:Peribulbar anaesthesia generally carries a low risk of serious complications, However, respiratory arrest and brainstem anaesthesia may occur as complications of peribulbar blocks. Conclusion : En general, I'anesthesie peribulbaire comporte un faible risque de complications seneuses, Un arr@t resp.-atolre par anesth6sie du tronc c@rebral est toujours possible.

show abstract

“…Inpatient care immediately after vitreoretinal surgery is intended to treat pain and nausea and to minimise ocular complications [1]. At the present time, the vast majority of vitreoretinal procedures are performed using either retrobulbar or peribulbar anaesthesia because of the advantages of the regional anaesthesia such as better pain relief and recovery as well as less postoperative nausea and vomiting [3–19]. Peribulbar anaesthesia has been used successfully for vitreoretinal surgery as a sole anaesthetic technique [15] and has been shown to be safer than retrobulbar anaesthesia [12–14].…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, retrobulbar block was the local anaesthetic method for ocular surgery. Because of the complications of retrobulbar block [5–10] and the safety and effectiveness of peribulbar block [11–14], the latter has gained wide acceptance in ophthalmic anaesthetic practice in recent times. Recent comparison of peribulbar and retrobulbar anaesthesia has documented that peribulbar anaesthesia can be expeditiously and efficiently used for a full range of vitreoretinal surgical procedure [15].…”

mentioning

confidence: 99%

Effects of peribulbar bupivacaine as an adjunct to general anaesthesia on peri‐operative outcome following retinal detachment surgery

2000

View full text Add to dashboard Cite

SummarySixty premedicated, ASA physical status I or II patients weighing . 25 kg scheduled for elective retinal detachment repair were randomly assigned to receive either peribulbar block with 10 ml of 0.25% bupivacaine (block group) or intravenous morphine 150 mg.kg 21 (morphine group), prior to the induction of general anaesthesia (n 30 in each group). Patients were evaluated for intraoperative oculocardiac reflex , peri-operative pain relief, recovery from anaesthesia and postoperative nausea and vomiting. Apart from significantly reducing the incidence of oculocardiac reflex (30% vs. 70%, p 0.0019), peribulbar bupivacaine also attenuated the severity of the reflex. Postoperative pain relief was superior in the block group. More block group patients had the maximum recovery score in the immediate postoperative period (80% vs. 27%, p , 0.0001) and they achieved complete recovery significantly faster than the morphine group (17.3 (14.7) min vs. 66.7 (29.7) min, p , 0.0001). The incidence (40% vs. 77%, p 0.004) and severity of postoperative nausea and vomiting were significantly less in the block group. In summary, peribulbar bupivacaine, when administered together with general anaesthesia, attenuated oculocardiac reflex, provided comparable intra-operative and superior postoperative analgesia, resulted in significantly earlier and better recovery from anaesthesia, and significantly reduced the incidence and severity of postoperative nausea and vomiting.

show abstract

Grand Mal Seizures after Retrobulbar Block

Cited by 6 publications

References 0 publications

Delayed Convulsions and Brief Contralateral Hemiparesis After Retrobulbar Block

Delayed Convulsions and Brief Contralateral Hemiparesis After Retrobulbar Block

Brainstem anaesthesia after peribulbar anaesthesia

Effects of peribulbar bupivacaine as an adjunct to general anaesthesia on peri‐operative outcome following retinal detachment surgery

Contact Info

Product

Resources

About