Calenda E, Rey N, Marguerite C, Muraine M
Département d'Anesthésie Réanimation, Rouen University Hospital, Hôpital Charles-Nicolle, Rouenx, France.
Acta Anaesthesiol Belg. 2009;60(1):47-50.
We report 3 cases of central retinal artery occlusion following peribulbar anesthesia. Those patients were scheduled for retinal detachment repair, removal of a pterygium, and cataract surgery, respectively. In patient 1, a peribulbar anesthesia was performed with 17 ml of ropivacaine and a compression with a Honan's balloon was maintained at 30 mmHg for 30 min to reduce intra ocular pressure and facilitate intra ocular surgery. In the second patient, 13 ml of ropivacaine was administered without compression of the ocular globe. Patient 3 received 14 ml of mepivacaine and compression was maintained at 30 mmHg for 10 min. In these 3 cases, the surgeon noticed a whitening of the retina during the postoperative period, corresponding with a typical occlusion of the central artery of the retina. Several mechanisms may be cited in an attempt to explain this retinal ischemia: the high volume injected, the speed of injection, a compression of the ocular globe at high pressures for a prolonged period of time, and/or an intrinsic vasoconstricting effect of local anesthetic agents.
我们报告了3例球周麻醉后发生视网膜中央动脉阻塞的病例。这些患者分别计划进行视网膜脱离修复术、翼状胬肉切除术和白内障手术。在患者1中，使用17毫升罗哌卡因进行球周麻醉，并使用Honan球囊以30 mmHg的压力持续压迫30分钟，以降低眼压并便于眼内手术。在第二名患者中，注射了13毫升罗哌卡因，未对眼球进行压迫。患者3接受了14毫升甲哌卡因，并以30 mmHg的压力持续压迫10分钟。在这3例病例中，外科医生在术后发现视网膜变白，这与典型的视网膜中央动脉阻塞相符。为了解释这种视网膜缺血，可能会列举几种机制：注射量过大、注射速度、长时间高压压迫眼球，和/或局部麻醉剂的内在血管收缩作用。
