Anestesia do tronco encefálico após bloqueio retrobulbar xxtraconal. É possível evitar? Relato de caso*
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2007-08
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BACKGROUND AND OBJECTIVES: The CEROF-HC is a public
hospital specialized in ophthalmology. Anesthetic blocks for
ophthalmic surgeries are common and effective. But the technique
is not devoid of risks, and there is the possibility of meningeal
perforation and injection of the local anesthetic (LA) in the central
nervous system (CNS). The objective of this study was to report a
case of brainstem anesthesia as a complication of the ophthal-
mologic regional anesthesia, stress the importance of preventing
this accident, and discuss the treatment.
CASE REPORT: A female patient, 60 years old, ASA II, with a
diagnosis of grade II cataract, was scheduled for a facectomy and
implantation of intraocular lens in the right eye. The patient had a
past medical history of hypertension and vitrectomy. Physical exam,
laboratory and cardiologic exams were normal. An extraconal
retrobulbar block was performed with local anesthetic (lidocaine
and bupivacaine) and hyaluronidase (total volume of 5 mL).
Immediately after, the patient developed apnea and loss of cons-
ciousness. She was treated with tracheal intubation and mechanical
ventilation, remaining stable. The surgery was performed as
planned. Thirty minutes after the intubation, the patient began to
move, recovering completely, without deficits.
CONCLUSIONS: Although safe, ophthalmic block is not devoid of
risks. The main risk factor is improper anesthetic technique. In the
ophthalmic block, the local anesthetic (LA) can reach the CNS by
inadvertently puncturing the ophthalmic artery or the meninges that
surround the optic nerve, with dispersion to the subarachnoid space.
Although rare, it can lead to a severe complication with respiratory
arrest that can be fatal if it is not diagnosed promptly. Here we
present the possibilities of such a complication, and discuss the
nomenclature of anesthetic blocks used in ophthalmology. The
importance of the knowledge of this and other complications by the
surgical team is paramount, as well as the preparation and adequate
monitoring to diagnose and treat immediately this complication to
minimize the risks to the patient.
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Anesthetic techniques, regional: peribulbar, retrobulbar extraconal, Complications: respiratory arrest; surgery, ophthalmic: cataract
Citação
CARNEIRO, Haroldo Maciel et al. Anestesia do tronco encefálico após bloqueio retrobulbar extraconal. É possível evitar? Relato de caso. Revista Brasileira de Anestesiologia, Rio de Janeiro, v. 57, n. 4, p. 391-400, 2007.