Brainstem Anesthesia During Retrobulbar Block: An Eye-Opener Clinical Case

Area of Science:

• Ophthalmology
• Anesthesiology
• Neurology

Background:

• Retrobulbar anesthetic blocks are standard for posterior eye surgeries.
• While generally safe, they carry risks, including rare but severe complications.

Observation:

• A 91-year-old patient developed sudden loss of consciousness, bilateral fixed pupils, tachycardia, hypertension, and apnea post-retrobulbar block.
• Symptoms resolved spontaneously over 4 hours, allowing successful extubation and discharge without sequelae.

Findings:

• Clinical presentation consistent with brainstem anesthesia.
• Likely caused by local anesthetic spread into the subarachnoid space via inadvertent dural or vascular puncture.
• Diagnostic workup revealed no other abnormalities.

Implications:

• Highlights the importance of high suspicion and rapid response for diagnosing and managing brainstem anesthesia.
• Emphasizes the need for continuous patient monitoring and the critical role of anesthesiologists in ophthalmic procedures.
• Suggests a systematic A-B-C-D-E approach for managing such rare complications, often leading to good patient outcomes.