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Leme FCO, Moro ET, Ferraz AAF. Amaurosis and contralateral cranial nerve pairs III and VI paralysis after peribulbar block – Case report. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 27554191 PMCID: PMC9391794 DOI: 10.1016/j.bjane.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background and objectives Peribulbar anesthesia has emerged as a safer option compared with intraconal retrobulbar block. Still, peribulbar anesthesia may not be considered without risk. Numerous complications have been described when performing this technique. This report aims to describe a rare case of amaurosis and contralateral paralysis while attempting to perform a peribulbar anesthesia. Case report Male patient, 75-year old, physical status ASA II, undergoing cataract surgery by phacoemulsification with intraocular lens implantation. Sedated with fentanyl and midazolam and subjected to peribulbar anesthesia. There were no complications during surgery. After finishing the procedure, the patient reported lack of vision in the contralateral eye. Akinesia of the muscles innervated by the cranial nerve pairs III and VI, ptosis, and medium-sized pupils unresponsive to light stimulus were observed. Four hours after anesthesia, complete recovery of vision and eyelid and eyeball movements was seen in the non-operated eye. Conclusions During peribulbar anesthesia, structures located in the intraconal space can be accidentally hit leading to complications such as described in the above report. Following the technical guidelines and using appropriate size needles may reduce the risk of such complication, but not completely.
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Affiliation(s)
- Fábio Caetano Oliveira Leme
- Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde, Departamento de Cirurgia, Sorocaba, SP, Brasil.
| | - Eduardo Toshiyuki Moro
- Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde, Departamento de Cirurgia, Sorocaba, SP, Brasil
| | - Alexandre Alberto Fontana Ferraz
- Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde, Departamento de Cirurgia, Sorocaba, SP, Brasil
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Urfalıoğlu A, Urfalıoğlu S, Öksüz G. The Knowledge of Eye Physicians on Local Anesthetic Toxicity and Intravenous Lipid Treatment: Questionnaire Study. Turk J Ophthalmol 2017; 47:320-325. [PMID: 29326848 PMCID: PMC5758766 DOI: 10.4274/tjo.79446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/19/2017] [Indexed: 12/01/2022] Open
Abstract
Objectives To evaluate the knowledge of ophthalmologists regarding local anesthesia toxicity syndrome (LATS) and intravenous lipid emulsion used in treatment, and to raise awareness of this issue. Materials and Methods A questionnaire comprising 14 questions about demographics, local anesthesia (LA) use, toxicity, and treatment methods was administered to ophthalmologists at different hospitals. Results The study included 104 ophthalmologists (25% residents, 67.3% specialists, 7.7% faculty members) with a mean age of 35.71±6.53 years. The highest number of participants was from state hospitals (65.4%), and 34.6% of the physicians had been working in ophthalmology for more than 10 years. Seventy-six percent of the participants reported using LA every day or more than twice a week, but 56.7% had received no specific training on this subject. No statistically significant difference was observed between different education levels and the rates of training (p=0.419). Bupivacaine was the most preferred LA and the majority of respondents (97.1%) did not use a test dose. Allergy (76%) and hypotension (68.3%) were the most common responses for early findings of LATS, while cardiac arrest (57.4%) and hepatotoxicity (56.4%) were given for late findings. The most common responses concerning the prevention of LATS included monitorization (72.4%) and use of appropriate doses (58.2%). Symptomatic treatment was selected by 72.4% of respondents and cardiopulmonary resuscitation and antihistamine treatment by 58.8%. Of the ophthalmologists in the study, 62.5% had never encountered LATS. The use of 20% intravenous lipid emulsion therapy for toxicity was known by 65% of the physicians, but only 1 participant stated having used it previously. Conclusion The importance of using 20% lipid emulsion in LATS treatment and having it available where LA is administered must be emphasized, and there should be compulsory training programs for ophthalmologists on this subject.
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Affiliation(s)
- Aykut Urfalıoğlu
- Sütçü İmam University Faculty of Medicine, Department of Anesthesiology and Reanimation, Kahramanmaraş, Turkey
| | - Selma Urfalıoğlu
- Necip Fazıl State Hospital, Opthalmology Clinic, Kahramanmaraş, Turkey
| | - Gözen Öksüz
- Sütçü İmam University Faculty of Medicine, Department of Anesthesiology and Reanimation, Kahramanmaraş, Turkey
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Kazancıoğlu L, Batçık Ş, Kazdal H, Şen A, Gediz BŞ, Erdivanlı B. Complication of Peribulbar Block: Brainstem Anaesthesia. Turk J Anaesthesiol Reanim 2017; 45:231-233. [PMID: 28868171 DOI: 10.5152/tjar.2017.95881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/24/2017] [Indexed: 01/29/2023] Open
Abstract
Peribulbar block is used to obtain anaesthesia and akinesia of the eye by injecting a local anaesthetic around the musclecone. A patient scheduled for cataract surgery received peribulbar block with 6 mL of 2% lidocaine hydrochloride. Following the injection, confusion, hypotension and dilatation of the contralateral pupil rapidly progressed to loss of consciousness and respiratory arrest. The patient was intubated and mechanically ventilated for 30 min. The patient regained her consciousness, was extubated and transferred to the intensive care unit for further follow-up. Although brainstem anaesthesia because of peribulbar block is very rare, this procedure should be performed with complete monitorisation and resuscitation equipment.
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Affiliation(s)
- Leyla Kazancıoğlu
- Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Şule Batçık
- Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Hızır Kazdal
- Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Ahmet Şen
- Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Berrak Şekeryapan Gediz
- Department of Eye Diseases, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Başar Erdivanlı
- Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
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Tolesa K, Gebreal GW. Brainstem Anesthesia after Retrobulbar Block: A Case Report and Review of Literature. Ethiop J Health Sci 2017; 26:589-594. [PMID: 28450776 PMCID: PMC5389080 DOI: 10.4314/ejhs.v26i6.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Retro-bulbar anesthesia is one of the most common regional blocks used for intraocular surgeries. Complications associated with regional blocks may be limited to the eye or may be systemic. Case Report After a retro-bulbar block for glaucoma surgery, a 60-year-old man developed loss of consciousness, apnea with hypotension and bradycardia-features of brainstem anesthesia. We present the clinical features, treatment and comments on how to prevent the problem as well as a review of the literature on reported cases. Conclusion Although it is rare, treating physicians should be aware of the potentially lethal consequences of retro-bulbar block, understand measures to reduce the risks and early recognition and treatment. Facilities where ophthalmic surgeries are performed under local anesthesia should be properly equipped and staffed for advanced resuscitation.
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Affiliation(s)
- Kumale Tolesa
- Department of Ophthalmology, Jimma University, Ethiopia
| | - Girum W Gebreal
- Department of Ophthalmology, St Paul's Hospital Millennium Medical College, Ethiopia
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Leme FCO, Moro ET, Ferraz AAF. [Amaurosis and contralateral cranial nerve pairs III and VI paralysis after peribulbar block - case report]. Rev Bras Anestesiol 2016; 68:299-302. [PMID: 27554191 DOI: 10.1016/j.bjan.2016.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Peribulbar anesthesia has emerged as a safer option compared with intraconal retrobulbar block. Still, peribulbar anesthesia may not be considered without risk. Numerous complications have been described when performing this technique. This report aims to describe a rare case of amaurosis and contralateral paralysis while attempting to perform a peribulbar anesthesia. CASE REPORT Male patient, 75-year old, physical status ASA II, undergoing cataract surgery by phacoemulsification with intraocular lens implantation. Sedated with fentanyl and midazolam and subjected to peribulbar anesthesia. There were no complications during surgery. After finishing the procedure, the patient reported lack of vision in the contralateral eye. Akinesia of the muscles innervated by the cranial nerve pairs III and VI, ptosis, and medium-sized pupils unresponsive to light stimulus were observed. Four hours after anesthesia, complete recovery of vision and eyelid and eyeball movements was seen in the non-operated eye. CONCLUSIONS During peribulbar anesthesia, structures located in the intraconal space can be accidentally hit leading to complications such as described in the above report. Following the technical guidelines and using appropriate size needles may reduce the risk of such complication, but not completely.
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Affiliation(s)
- Fábio Caetano Oliveira Leme
- Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde, Departamento de Cirurgia, Sorocaba, SP, Brasil.
| | - Eduardo Toshiyuki Moro
- Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde, Departamento de Cirurgia, Sorocaba, SP, Brasil
| | - Alexandre Alberto Fontana Ferraz
- Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde, Departamento de Cirurgia, Sorocaba, SP, Brasil
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Benitez PRB, Nogueira CS, de Holanda ACC, Santos JC. Lumbar spinal anesthesia with cervical nociceptive blockade. Critical review of a series of 1,330 procedures. Braz J Anesthesiol 2016; 66:86-93. [PMID: 26768937 DOI: 10.1016/j.bjane.2014.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 05/26/2014] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The manufacture of minimally traumatic needles and synthesis of pharmacological adjuncts with safe and effective action on inhibitory and neuromodulatory synapses distributed along the nociceptive pathways were crucial for a new expansion phase of spinal anesthesia. The objectives of this paper are present our clinical experience with 1330 lumbar spinal anesthesia performed with purposeful nociceptive blockade of the thoracic and cervical spinal nerves corresponding to dermatomes C4 or C3; warn about the method pathophysiological risks, and emphasize preventive standards for the safe application of the technique. CONTENT Review of the historical background and anatomical spinal anesthesia with cervical levels of analgesia. Description of the technique used in our institution; population anesthetized; and surgery performed with the described method. Critical exposition of the physiological, pathophysiological, and clinical effects occurred and registered during anesthesia-surgery and postoperative period. CONCLUSION Spinal anesthesia with nociceptive blockade to dermatome C4, or C3, is an effective option for surgery on somatic structures distal to the metamer of the third cervical spinal nerve, lasting no more than four or five hours. The method safety depends on the unrestricted respect for the essential rules of proper anesthesia.
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Affiliation(s)
| | - Celso Schmalfuss Nogueira
- Superior Title of Anesthesiology, Sociedade Brasileira de Anestesiologia (SBA), Rio de Janeiro, RJ, Brazil
| | | | - José Caio Santos
- Superior Title of Anesthesiology, Sociedade Brasileira de Anestesiologia (SBA), Rio de Janeiro, RJ, Brazil
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Benitez PRB, Nogueira CS, Holanda ACCD, Santos JC. [Lumbar spinal anesthesia with cervical nociceptive blockade. Critical review of a series of 1,330 procedures]. Rev Bras Anestesiol 2014; 66:86-93. [PMID: 25535113 DOI: 10.1016/j.bjan.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 05/26/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The manufacture of minimally traumatic needles and synthesis of pharmacological adjuncts with safe and effective action on inhibitory and neuromodulatory synapses distributed along the nociceptive pathways were crucial for a new expansion phase of spinal anesthesia. The objectives of this paper are present our clinical experience with 1,330 lumbar spinal anesthesia performed with purposeful nociceptive blockade of the thoracic and cervical spinal nerves corresponding to dermatomes C4 or C3; warn about the method pathophysiological risks, and emphasize preventive standards for the safe application of the technique. CONTENT Review of the historical background and anatomical spinal anesthesia with cervical levels of analgesia. Description of the technique used in our institution; population anesthetized; and surgery performed with the described method. Critical exposition of the physiological, pathophysiological, and clinical effects occurred and registered during anesthesia-surgery and postoperative period. CONCLUSION Spinal anesthesia with nociceptive blockade to dermatome C4, or C3, is an effective option for surgery on somatic structures distal to the metamer of the third cervical spinal nerve, lasting no more than four or five hours. The method safety depends on the unrestricted respect for the essential rules of proper anesthesia.
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Affiliation(s)
- Percio Ramón Becker Benitez
- Título Superior de Anestesiologia, Sociedade Brasileira de Anestesiologia (SBA), Rio de Janeiro, RJ, Brasil.
| | - Celso Schmalfuss Nogueira
- Título Superior de Anestesiologia, Sociedade Brasileira de Anestesiologia (SBA), Rio de Janeiro, RJ, Brasil
| | | | - Jose Caio Santos
- Título Superior de Anestesiologia, Sociedade Brasileira de Anestesiologia (SBA), Rio de Janeiro, RJ, Brasil
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