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Central nervous system complications after 6000 retrobulbar blocks
J M Nicoll1, P A Acharya, K Ahlen
1Department of Anesthesia, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Anesthesia and Analgesia
|December 1, 1987
Summary
Retrobulbar anesthesia for ophthalmic surgery can lead to central nervous system complications in 1 in 375 patients. While rare, these serious adverse events necessitate closely monitored anesthesia care.
Area of Science:
- Anesthesiology
- Ophthalmology
- Neurology
Background:
- Retrobulbar anesthesia is a common technique for ophthalmic surgery.
- Direct spread of local anesthetic to the central nervous system (CNS) is a potential complication.
Purpose of the Study:
- To investigate the incidence and spectrum of CNS complications following retrobulbar anesthesia.
- To assess the predictability and severity of these adverse events.
Main Methods:
- Retrospective analysis of 6,000 consecutive patients undergoing retrobulbar anesthesia.
- Documentation of all observed neurological and systemic signs and symptoms post-injection.
Main Results:
- Sixteen patients (1 in 375) experienced CNS complications.
- Symptoms ranged from mild drowsiness to severe events like respiratory depression, seizures, and cardiopulmonary arrest.
- Onset time was variable (average 8 minutes), and severity was unrelated to anesthetic dose.
- Life-threatening complications occurred rarely (1 in 750) but were unpredictable.
Conclusions:
- Direct CNS spread of local anesthetics during retrobulbar anesthesia is an infrequent but serious risk.
- The unpredictable nature and potential severity underscore the need for vigilant monitoring.
- Continuous anesthesia care is crucial for patients receiving retrobulbar anesthesia.
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