Pulmonary oedema after ophthalmic regional anaesthesia in an unfasted patient undergoing elective surgery

An elderly female patient presenting for phaco-emulsification and intra-ocular lens implant under local anaesthesia developed pulmonary oedema after surgery and underwent emergency tracheal intubation. The pulmonary oedema may have been caused by her omission of routine oral diuretic medication before surgery and having to lie flat for the procedure. The patient had not been fasted before surgery, as is accepted practice in many hospitals. This made emergency tracheal intubation potentially hazardous. The patient made a full recovery. The issues of pre-operative assessment, fasting and the withholding of diuretic medication before elective eye surgery under local anaesthesia are discussed.