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[Sudden decrease in the level of consciousness due to subarachnoid bleeding attack in a patient undergoing ophthalmic
Masui. the Japanese Journal of Anesthesiology
|March 11, 1998
Summary
A sudden decrease in consciousness during retrobulbar anesthesia may indicate subarachnoid bleeding, not local anesthetic toxicity. Prompt diagnosis and intervention are crucial for patient safety during ophthalmic surgery.
Area of Science:
- Ophthalmology
- Neurology
- Anesthesiology
Background:
- Retrobulbar anesthesia is commonly used for ophthalmic procedures.
- Complications can arise, including local anesthetic systemic toxicity (LAST).
- Sudden neurological changes during surgery require rapid differential diagnosis.
Observation:
- A 71-year-old female experienced a sudden decrease in consciousness, respiratory depression, and hypertension immediately after retrobulbar anesthesia.
- Similar episodes recurred during the same surgical procedure.
- Symptoms mimicked acute local anesthetic intoxication.
Findings:
- Computed tomography confirmed subarachnoid bleeding from a ruptured anterior cerebral artery aneurysm.
- The patient's symptoms were attributed to cerebrovascular events, not local anesthetic toxicity.
- Successful management involved supportive care, anticonvulsants, and antihypertensives.
Implications:
- Sudden neurological deterioration under local anesthesia warrants immediate surgical termination to investigate potential serious cardiovascular or cerebrovascular events.
- Distinguishing between LAST and other critical conditions is vital for appropriate management.
- This case highlights the importance of considering non-anesthetic causes for intraoperative neurological changes.