Dettoraki Maria, Dimitropoulou Chrisafoula, Nomikarios Nikolaos, Moschos Marilita M, Brοuzas Dimitrios
1st Department of Ophthalmology, University of Athens, "G. Gennimatas" General Hospital of Athens, 10 G. Papandreou Str, Byron, Athens, 16231, Greece.
Department of Anesthesiology, "G. Gennimatas" General Hospital of Athens, Athens, Greece.
BMC Anesthesiol. 2015 Jul 28;15:108. doi: 10.1186/s12871-015-0084-y.
Retrobulbar block is a local anesthetic technique widely used for intraocular surgery. Although retrobulbar anesthesia is considered to be relatively safe, a number of serious adverse events have been reported. To our knowledge, immediate onset of generalized seizures with contralateral hemiparesis after retrobulbar anesthesia has not been reported.
A 62-year-old Caucasian healthy male with a right eye retinal detachment was admitted for pars plana vitrectomy. During retrobulbar anesthesia with ropivacaine and before needle withdrawal, the patient developed twitching of the face which rapidly progressed to generalized tonic-clonic seizures. Arterial oxygen saturation decreased to 75 %. Chin lift was performed and 100 % oxygen was administrated via face mask, which increased saturation to 99 %. Midazolam 2 mg was administrated intravenously to control seizures. After cessation of seizures, left-sided hemiparesis was evident. Brain computed tomography and electroencephalogram were normal 3 h later. The patient underwent pars plana vitrectomy under general anesthesia 4 days later.
Serious complications of local anesthesia for ophthalmic surgery are uncommon. We present a case in which generalized tonic-clonic seizures developed during retrobulbar anesthesia, followed by transient contralateral hemiparesis. The early onset of seizures indicated intra-arterial injection of the anesthetic. Our case suggested the need for close monitoring during the performance of retrobulbar anesthesia and the presence of well-trained personnel for early recognition and immediate management of the complications.
球后阻滞是一种广泛用于眼科手术的局部麻醉技术。尽管球后麻醉被认为相对安全，但仍有一些严重不良事件的报道。据我们所知，球后麻醉后立即出现全身性癫痫发作并伴有对侧偏瘫的情况尚未见报道。
一名62岁的白种健康男性因右眼视网膜脱离入院接受玻璃体切除术。在使用罗哌卡因进行球后麻醉过程中，拔针前患者出现面部抽搐，迅速发展为全身性强直阵挛性癫痫发作。动脉血氧饱和度降至75%。进行了抬颏操作，并通过面罩给予100%氧气，使饱和度升至99%。静脉注射2mg咪达唑仑以控制癫痫发作。癫痫发作停止后，左侧偏瘫明显。3小时后脑部计算机断层扫描和脑电图检查正常。4天后患者在全身麻醉下接受了玻璃体切除术。
眼科手术局部麻醉的严重并发症并不常见。我们报告了一例在球后麻醉期间发生全身性强直阵挛性癫痫发作，随后出现短暂性对侧偏瘫的病例。癫痫发作的早期发生提示麻醉剂动脉内注射。我们的病例表明在进行球后麻醉时需要密切监测，并配备训练有素的人员以便早期识别和立即处理并发症。
