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Related Experiment Videos

[Sudden decrease in the level of consciousness due to subarachnoid bleeding attack in a patient undergoing ophthalmic

H Adachi1, T Tashiro, T Tashiro

  • 1Department of Anesthesiology, Kumamoto Red Cross Hospital.

Masui. the Japanese Journal of Anesthesiology
|March 11, 1998
PubMed
Summary

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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.

Related Experiment Videos

  • 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.