Convulsions during cataract surgery under peribulbar anesthesia: a case report

Journal of Medical Case Reports

Hicham Azendour¹  Charki Haimeur¹  Hicham Balkhi¹  Abdelhafid Houba¹  Najlae Badou¹  Mustapha Bensghir¹ 

[1] Department of Anesthesiology Military Hospital Mohammed V Rabat, University of Mohammed V Souissi, Rabat, Morocco

关键词: Peribulbar anesthesia;    Convulsions;    Cataract surgery;    Brainstem anesthesia;   

Others  :  813924
DOI  :  10.1186/1752-1947-8-218

 received in 2013-11-25, accepted in 2014-04-28,  发布年份 2014

【 摘 要 】

Introduction

Locoregional 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 presentation

A 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.

Conclusions

Various 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.

【 授权许可】

   
2014 Bensghir et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Haberer JP, Obstler C: Anesthésie en Ophtalmologie. Paris: Elsevier Masson SAS; 2008:1-24. [EMC Anesthésie-Réanimation] 36-620-E-30
• [2]McGoldrick KE, Foldes PJ: General anesthesia for ophthalmic surgery. Ophthalmol Clin North Am 2006, 19:179-191.
• [3]Ripart J, Nouvellon E, Chaumeron A: Regional anesthesia for eye surgery. Reg Anesth Pain Med 2005, 30:72-82.
• [4]Nouvellon E, Cuvillon P, Ripart J: Regional anesthesia and eye surgery. Anesthesiology 2010, 113:1236-1242.
• [5]Aqil M: Local anesthesia for the ophthalmic surgery. Select the best technique for your patient. Saudi Med J 2010, 31:605-614.
• [6]Kumar C, Dowd T: Ophthalmic regional anaesthesia. Curr Opin Anaesthesiol 2008, 21:632-637.
• [7]Weiss JL, Deichman CB: A comparison of retrobulbar and periocular anesthesia for cataract surgery. Arch Ophthalmol 1989, 107:96-98.
• [8]Alhassan MB, Kyari F, Ejere HO: Peribulbar versus retrobulbar anaesthesia for cataract surgery. Cochrane Database Syst Rev 2008., 16(3) CD004083. doi:10.1002/14651858.CD004083.pub2
• [9]Davis DB, Mandel MR: Peribulbar anesthesia. A review of technique and complications. Ophthalmol Clin North Am 1990, 3:101-110.
• [10]Rouxel JM, Zahwa A, Obstler C, Haberer JP: Complications de l’anesthésie rétrobulbaire et péribulbaire. Cah Anesthesiol 1997, 45:193-205.
• [11]Davis DB 2nd, Mandel MR: Efficacy and complication rate of 16,224 consecutive peribulbar blocks. A prospective multicenter study. J Cataract Refract Surg 1994, 20:327-337.
• [12]Boret H, Petit D, Ledantec P, Bénéfice S: Brainstem anesthesia after peribulbar anesthesia. Ann Fr Anesth Reanim 2002, 21:725-727.
• [13]Rozentsveig V, Yagev R, Wecksler N, Gurman G, Lifshitz T: Respiratory arrest and convulsions after peribulbar anesthesia. J Cataract Refract Surg 2001, 27:960-962.
• [14]Gomez R, Andrade L, Rezende Costa JR: Brainstem anaesthesia after peribulbar anesthesia. Can J Anaesth 1997, 44:732-734.
• [15]Aldrete JA, Romo-Salas F, Arora S, Wilson R, Rutherford R: Reverse arterial blood flow as a pathway for central nervous system toxic responses following injection of local anesthetics. Anesth Analg 1978, 57:428-433.
• [16]Meyers EF, Ramirez RC, Boniuk I: Grand mal seizures after retrobulbar block. Arch Ophthalmol 1978, 96:847.
• [17]Rosenblatt RM, May DR, Barsoumian K: Cardiopulmonary arrest after retrobulbar block. Am J Ophthalmol 1980, 90:425-427.
• [18]Hamilton RC: Brain-stem anesthesia as a complication of regional anesthesia for ophthalmic surgery. Can J Ophthalmol 1992, 27:323-325.
• [19]Renato S, Gomez MSC, Andrade LOF, Rezende Costa JR: Brainstem anaesthesia after peribulbar anaesthesia. Can J Anaesth 1997, 44:732-734.
• [20]Edge KR, Davis A: Brainstem anaesthesia following a peribulbar block for eye surgery. Anaesth Intensive Care 1995, 23:219-221.
• [21]Singer SB, Preston RG, Hodge W: Respiratory arrest following anesthesia for cataract surgery: case report and review of the literature. Can J Ophthalmol 1997, 32:450-454.
• [22]Kobet KA: Cerebral spinal fluid recovery of lidocaine and bupivacaine following respiratory arrest subsequent to retrobulbar block. Ophtalmic Surg 1987, 1:11-13.
• [23]Red JW, Mac Millan AS, Lazenby GW: Transient neurologic complication of positive contrast orbitography. Arch Ophtalmol 1969, 81:508-511.
• [24]Katsev DA, Drews RC, Rose BT: An anatomic study of retrobulbar needle path length. Ophthalmology 1989, 96:1221-1224.
• [25]Ortiz M, Valls R, Vallès J, Blanco D, Vidal F: Topography of peribulbar anesthesia. Reg Anesth 1995, 20:337-342.
• [26]Shantha TR: The relationship of retrobulbar local anaesthetic spread to the neural membranes of the eyeball, optic nerve, and arachnoid villi in the optic nerve. Anesthesiology 1990, 72(3A):A849.
• [27]Chandradeva K, Nangalia V, Hugkulstone CE: Role of the anaesthetist during cataract surgery under local anaesthesia in the UK: a national survey. Br J Anaesth 2010, 104:577-581.
• [28]Merry AF, Cooper JB, Soyannwo O, Wilson IH, Eichhorn JH: International standards for a safe practice of anesthesia 2010. Can J Anaesth 2010, 57:1027-1034.
• [29]Mellin-Olsen J, Staender S, Whitaker DK, Smith AF: The Helsinki declaration on patient safety in anaesthesiology. Eur J Anaesthesiol 2010, 27:592-597.
• [30]Kumar CM, Eke T, Dodds C, Deane JS, El-Hindy N, Johnston RL, Kong KL, McLure HA, Shah P, Tighe SQ, Vohra SB: Local anaesthesia for ophthalmic surgery – new guidelines from the Royal College of Anaesthetists and the Royal College of Ophthalmologists. Eye (Lond) 2012, 26:897-898.
• [31]Luyet C, Eichenberger U, Moriggl B, Remonda L, Greif R: Real-time visualization of ultrasound-guided retrobulbar blockade: an imaging study. Br J Anaesth 2008, 101:855-859.
• [32]Chang WM, Stetten GD, Lobes LA Jr, Shelton DM, Tamburo RJ: Guidance of retrobulbar injection with real-time tomographic reflection. J Ultrasound Med 2002, 21:1131-1135.
• [33]Luyet C, Eng KT, Kertes PJ, Avila A, Muni RH, McHardy P: Real-time evaluation of diffusion of the local anesthetic solution during peribulbar block using ultrasound imaging and clinical correlates of diffusion. Reg Anesth Pain Med 2012, 37:455-459.