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Respiratory arrest following retrobulbar anesthesia
Ophthalmology
|July 1, 1986
Summary
Using 4% lidocaine in retrobulbar anesthesia significantly increases the risk of respiratory arrest compared to 2% lidocaine. This complication is not linked to elevated serum anesthetic levels, suggesting alternative mechanisms.
Area of Science:
- Anesthesiology
- Ophthalmology
Background:
- Retrobulbar anesthesia is a common procedure in ophthalmic surgery.
- Respiratory arrest is a rare but serious complication associated with retrobulbar anesthesia.
Purpose of the Study:
- To determine the incidence of respiratory arrest following retrobulbar anesthesia.
- To identify potential risk factors, specifically the concentration of lidocaine used.
Main Methods:
- A prospective study of 3123 retrobulbar injections was conducted.
- Injections used a mixture of lidocaine (2% or 4%) and bupivacaine with hyaluronidase.
- Serum anesthetic levels were measured in patients who experienced arrest and compared to controls.
Main Results:
- The incidence of respiratory arrest was significantly higher with 4% lidocaine (0.79%) compared to 2% lidocaine (0.09%) (P = 0.003).
- Serum lidocaine and bupivacaine levels in patients who arrested were not significantly elevated and remained below toxic thresholds.
Conclusions:
- The use of 4% lidocaine in retrobulbar anesthesia increases the risk of respiratory arrest.
- The mechanism of arrest is unlikely to be direct intravascular injection or central nervous system toxicity due to anesthetic levels.