Grand Mal Seizures After Retrobulbar Block

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

doi:10.1001/archopht.1978.03910050453011

Cited by 107 publications

(8 citation statements)

References 2 publications

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“…However, categorical quality of injection and non-injection techniques may explain the different risk of adverse events: concerning injection techniques (i.e. PBA), even when using a very short needle, anomalous positioning of the inferior ophthalmic artery can lead to an intra-arterial injection, which can result in retrograde arterial flow of the local anaesthetic agent [24, 25]. A large anaesthetic dose may result in cardiovascular disorders.…”

Section: Discussionsupporting

confidence: 39%

Systemic Adverse Events: A Comparison between Topical and Peribulbar Anaesthesia in Cataract Surgery

Stupp

Hassouna²,

Soppart

et al. 2007

Ophthalmologica

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Aims: To evaluate the safety of topical anaesthesia (TA) versus peribulbar anaesthesia (PBA) in patients undergoing routine cataract surgery on the basis of systemic adverse events. Methods: In this retrospective study, a total of 2,020 consecutive cases of cataract surgery performed by one surgeon on 1,621 patients with PBA (n = 1,010; between 1998–1999) or TA (n = 1,010; between 1999–2001) were evaluated on the basis of intra-operative and early postoperative adverse events requiring medical intervention. Results: The rate of pre-existing risk factors in patients undergoing cataract surgery is high (97%). Complications are significantly less frequent in TA than in PBA in the intra-operative (p < 0.001) and postoperative (p = 0.022) courses. The incidence of intra-operative complications is higher in elderly patients (≧65 years of age) than in younger patients (p < 0.001). Conclusion: The results from the present study indicate that intra-operative complications are less likely in patients that receive TA, suggesting the use of TA for routine cataract surgery both in young patients and particularly in elderly patients when there are no contraindications in the individual case.

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Section: Discussionsupporting

confidence: 39%

Systemic Adverse Events: A Comparison between Topical and Peribulbar Anaesthesia in Cataract Surgery

Stupp

Hassouna²,

Soppart

et al. 2007

Ophthalmologica

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“…Indeed the ophthalmic artery is in an abnormal position inferior to the optic nerve in 15% of cases, this exposes inadvertent intra-arterial injection during a PBA [16]. In this case, the direct exposure of brain structures to a low volume of LAA is similar to intoxication after inadvertent peripheral intra-arterial injection of a large volume of LAA, thereby clinical presentation is similar.…”

Section: Discussionmentioning

confidence: 94%

“…The injection pressure can reverse the direction of blood flow in the artery and the anesthetic solution flows back into the internal carotid artery and is delivered to the thalamus and other midbrain structures [14-16]. …”

Section: Discussionmentioning

confidence: 99%

Convulsions during cataract surgery under peribulbar anesthesia: a case report

et al. 2014

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IntroductionLocoregional anesthesia techniques are increasingly used for cataract surgery. From these techniques, peribulbar anesthesia has been very successful over the retrobulbar anesthesia seen its effectiveness and safety. However, peribulbar anesthesia is not without risk.Case presentationA 70-year-old African man was scheduled for cataract surgery and lens implant for his right eye. His medical history included hypertension, diabetes mellitus and gall bladder surgery. There were no personal or family antecedents of allergy, epilepsy or taking food or toxic drug. No abnormalities were detected in his preoperative evaluation. In the operating room, standard monitoring was installed and a peripheral venous catheter 18g was inserted. Peribulbar anesthesia was realized with two injections in primary gaze position. The anesthetic mixture contained lidocaine 2% and bupivacaine 0.5%. The needle used was 25GA, 19mm, ¾ inch. The first injection was performed in his lower temporal peribulbar space with 5mL of mixture; the second injection was performed with 3mL of mixture in his upper nasal peribulbar space. These injections were performed after a negative aspiration test and followed by manual compression of his globe for 5 minutes. Five minutes after peribulbar anesthesia, his blood pressure increased to 209/115mmHg requiring three bolus of nicardipine (3.0mg) to reduce his blood pressure to 134/56mmHg. One minute after, he had generalized tonic–clonic seizures. Tracheal intubation was performed. His capillary blood glucose was 170mg/dL, axillary temperature was 36.5°C, and his serum electrolytes were normal. He recovered spontaneous ventilation 1.5 hours later. A neurological examination noted no deficit. Extubation was performed 15 minutes later without incident. A brain computed tomography and electroencephalogram were unremarkable. He was discharged on the second day and operated on 1 month later under general anesthesia.ConclusionsVarious serious complications can occur during locoregional anesthesia techniques in ophthalmic surgery. The mastering and perfecting of these techniques by practitioners and compliance with safety standards in anesthesia are the only way to guarantee the prevention of such complications.

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“…The inferior ophthalmic artery may be prone to injury because in 15% of cases, it has an anomalous position inferior to the optic nerve (4). Such inadvertent intra-arterial injection of LA produces retrograde flow through the ophthalmic artery into the internal carotid artery.…”

Section: Discussionmentioning

confidence: 99%

“…This event induces immediate CNS symptoms such as respiratory arrest and hemodynamic changes. The classic clinical picture resulting from intra-arterial injection is, however, the immediate onset of grand mal seizure activity as the predominant sign (4). Diffusion of the anesthetic drug through the fine regional vasculature to the central circulation can also lead to similar symptoms.…”

Section: Discussionmentioning

confidence: 99%