Brainstem anesthesia after retrobulbar block under brief analgosedation: Evidence for the underlying patho-mechanism.

IF 1.4 4区 医学 Q3 OPHTHALMOLOGY
European Journal of Ophthalmology Pub Date : 2025-07-01 Epub Date: 2025-04-16 DOI:10.1177/11206721251333266
M A Thomasius, M Menghini, J Breckwoldt
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引用次数: 0

Abstract

Background: Retrobulbar block is a popular regional anesthetic technique in modern eye surgery due to its excellent anesthetic properties and the provision of globe akinesia. Severe complications including inadvertent subarachnoidal injection, expulsive retrobulbar hemorrhage, and intoxication with local anesthetic, are very rare. However, most reports date back several decades, mechanisms of action are not fully understood, and in recent years the procedure has changed towards facilitating the retrobulbar injection by a brief analgosedation. We therefore describe a case with inadvertent brainstem anesthesia after retrobulbar block concealed behind an analgosedation and provide cCT (cranial computed tomography) images with characteristic pathological findings. Therapy and outcome: A man in his mid-60´s presenting with retinal detachment was scheduled for surgery. After uneventful retrobulbar injection under brief analgosedation, a severe increase of blood pressure and tachycardia occurred while unconsciousness (originally induced by analgosedation) persisted. Hemodynamic alterations were treated with betablockers and antihypertensive agents, and the patient was intubated and mechanically ventilated. The diagnostic workup revealed a dural fissure with intracranial air in the cCT-scan compatible with a perforation of the dura and accidental injection of local anesthetics into the subarachnoidal space. The patient was kept intubated on ICU throughout the respiratory depression and fully recovered without neurological deficits. The vitreoretinal procedure was performed under general anesthesia 36 h after the event. Conclusion: Albeit rare, inadvertent brainstem anesthesia remains a serious adverse event of retrobulbar block. As an important aspect, analgosedation may mask the typical clinical signs making the diagnostic work-up challenging. Furthermore, for the first time we present radiographic imaging findings providing insightful evidence for a possible mechanism of action. Serious complications, such as prolonged hypoxia with potential neurological damage, can successfully prevented by ensuring the presence of a fully equipped and skilled anesthetic team throughout the regional anesthetic procedure.

短暂镇痛镇静下球后阻滞后的脑干麻醉:潜在病理机制的证据。
背景:球后阻滞术因其优异的麻醉性能和提供全球运动功能而成为现代眼科手术中流行的区域麻醉技术。严重的并发症包括不小心的蛛网膜下注射,排出性球后出血和局部麻醉中毒,是非常罕见的。然而,大多数报告都是在几十年前,其作用机制尚不完全清楚,近年来,该程序已改为通过短暂的镇痛作用促进球后注射。因此,我们描述了一个病例,无意的脑干麻醉后,球后阻滞隐藏在镇痛镇静后,并提供cCT(颅计算机断层扫描)图像的特征性病理发现。治疗和结果:一名60多岁的男性因视网膜脱离被安排进行手术。在短暂的镇痛镇静下,平稳的球后注射后,血压和心动过速严重升高,而意识(最初由镇痛镇静引起)持续存在。血流动力学改变给予β受体阻滞剂和降压药治疗,患者插管并机械通气。诊断检查显示硬脑膜裂,ct扫描显示颅内有空气,伴有硬脑膜穿孔和意外向蛛网膜下腔注射局麻药。患者在整个呼吸抑制期间一直在ICU插管,并完全恢复,无神经功能障碍。事件发生后36小时在全身麻醉下进行玻璃体视网膜手术。结论:尽管罕见,但无意的脑干麻醉仍然是球后阻滞的严重不良事件。作为一个重要的方面,镇痛可能掩盖了典型的临床症状,使诊断工作具有挑战性。此外,我们首次提出放射成像结果,为可能的作用机制提供了有见地的证据。严重的并发症,如长时间缺氧和潜在的神经损伤,可以通过确保在整个区域麻醉过程中有一个设备齐全和熟练的麻醉团队来成功预防。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.60
自引率
0.00%
发文量
372
审稿时长
3-8 weeks
期刊介绍: The European Journal of Ophthalmology was founded in 1991 and is issued in print bi-monthly. It publishes only peer-reviewed original research reporting clinical observations and laboratory investigations with clinical relevance focusing on new diagnostic and surgical techniques, instrument and therapy updates, results of clinical trials and research findings.
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