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Death associated with an indwelling orbital catheter
Sumit Garg1, Alfio Piva, Ruben N Sanchez
1Doheny Eye Institute, Department of Ophthalmology, Keck/USC School of Medicine, Los Angeles, California 90033, USA.
Ophthalmic Plastic and Reconstructive Surgery
|September 25, 2003
Summary
A fatal case highlights the risks of indwelling orbital catheters for ophthalmic surgery. Postoperative anesthesia via catheter led to respiratory arrest and death due to unintended subarachnoid injection, possibly linked to Stickler syndrome.
Area of Science:
- Ophthalmology
- Anesthesiology
- Genetics
Background:
- Revision of orbital implants can necessitate postoperative anesthesia.
- Indwelling orbital catheters offer a method for continuous drug delivery.
- Stickler syndrome is a connective tissue disorder affecting collagen.
Observation:
- A patient with Stickler syndrome received Marcaine via an indwelling orbital catheter at home post-surgery.
- The catheter migrated through the superior orbital fissure into the subarachnoid space.
- This resulted in unintended subarachnoid injection of Marcaine.
Findings:
- The patient experienced respiratory arrest and died despite resuscitation.
- Autopsy confirmed catheter malposition and subarachnoid injection.
- Connective tissue weakness, potentially due to collagen II deficiency in Stickler syndrome, may have facilitated catheter migration.
Implications:
- This case may represent a novel complication of indwelling orbital catheters in ophthalmic surgery.
- It underscores the potential risks associated with home administration of anesthesia via indwelling catheters.
- Recommendations include performing indwelling orbital catheter placement in a controlled hospital setting to mitigate risks.