A Case of Brainstem Anesthesia after Retrobulbar Block for Globe Rupture Repair
Purpose. To present a rare case of brainstem anesthesia from retrobulbar block and discuss evidence-based methods for reducing the incidence of this complication. Case. A 72-year-old female, was given a retrobulbar block of 5 mL of bupivacaine 0.5% for postoperative pain management, after a globe ru...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Case Reports in Anesthesiology |
| Online Access: | http://dx.doi.org/10.1155/2021/2619327 |
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| author | Tavish Nanda Lisa Ross Gregory Kerr |
| author_facet | Tavish Nanda Lisa Ross Gregory Kerr |
| author_sort | Tavish Nanda |
| collection | DOAJ |
| description | Purpose. To present a rare case of brainstem anesthesia from retrobulbar block and discuss evidence-based methods for reducing the incidence of this complication. Case. A 72-year-old female, was given a retrobulbar block of 5 mL of bupivacaine 0.5% for postoperative pain management, after a globe rupture repair under general anesthesia. Prior to injection, the patient was breathing spontaneously via the anesthesia machine circuit and had not received any additional narcotics/muscle relaxants for 2.5 hr (with full recovery of neuromuscular blocking agent after anesthetic reversal). Over 7 min, however, there was a steady increase in ETCO2 and the patient became apneic, consistent with brainstem anesthesia. She remained intubated and was transported to the postanesthesia care unit for prolonged monitoring, with eventual extubation. Discussion. Brainstem anesthesia is an important complication to recognize as it can lead to apnea and death. The judicious use of anesthetic volume, shorter needle tips, and mixed formulations can help reduce the chance of brainstem anesthesia. Observation of the contralateral eye 5–10 minutes after injection for pupillary dilation, and prior to surgical draping, can help identify early CNS involvement. |
| format | Article |
| id | doaj-art-1791717596cc4cd8b39a9fe3d7faa3cb |
| institution | Kabale University |
| issn | 2090-6390 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Anesthesiology |
| spelling | doaj-art-1791717596cc4cd8b39a9fe3d7faa3cb2025-02-03T01:33:19ZengWileyCase Reports in Anesthesiology2090-63902021-01-01202110.1155/2021/2619327A Case of Brainstem Anesthesia after Retrobulbar Block for Globe Rupture RepairTavish Nanda0Lisa Ross1Gregory Kerr2Department of OphthalmologyDepartment of AnesthesiaDepartment of AnesthesiaPurpose. To present a rare case of brainstem anesthesia from retrobulbar block and discuss evidence-based methods for reducing the incidence of this complication. Case. A 72-year-old female, was given a retrobulbar block of 5 mL of bupivacaine 0.5% for postoperative pain management, after a globe rupture repair under general anesthesia. Prior to injection, the patient was breathing spontaneously via the anesthesia machine circuit and had not received any additional narcotics/muscle relaxants for 2.5 hr (with full recovery of neuromuscular blocking agent after anesthetic reversal). Over 7 min, however, there was a steady increase in ETCO2 and the patient became apneic, consistent with brainstem anesthesia. She remained intubated and was transported to the postanesthesia care unit for prolonged monitoring, with eventual extubation. Discussion. Brainstem anesthesia is an important complication to recognize as it can lead to apnea and death. The judicious use of anesthetic volume, shorter needle tips, and mixed formulations can help reduce the chance of brainstem anesthesia. Observation of the contralateral eye 5–10 minutes after injection for pupillary dilation, and prior to surgical draping, can help identify early CNS involvement.http://dx.doi.org/10.1155/2021/2619327 |
| spellingShingle | Tavish Nanda Lisa Ross Gregory Kerr A Case of Brainstem Anesthesia after Retrobulbar Block for Globe Rupture Repair Case Reports in Anesthesiology |
| title | A Case of Brainstem Anesthesia after Retrobulbar Block for Globe Rupture Repair |
| title_full | A Case of Brainstem Anesthesia after Retrobulbar Block for Globe Rupture Repair |
| title_fullStr | A Case of Brainstem Anesthesia after Retrobulbar Block for Globe Rupture Repair |
| title_full_unstemmed | A Case of Brainstem Anesthesia after Retrobulbar Block for Globe Rupture Repair |
| title_short | A Case of Brainstem Anesthesia after Retrobulbar Block for Globe Rupture Repair |
| title_sort | case of brainstem anesthesia after retrobulbar block for globe rupture repair |
| url | http://dx.doi.org/10.1155/2021/2619327 |
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