Ananthanarayan C, Cole A F, Kazdan M
Department of Anaesthesia, Mount Sinai Hospital, University of Toronto, Ontario.
Can J Anaesth. 1997 Jun;44(6):658-61. doi: 10.1007/BF03015451.
To present a case of difficult intubation with brainstem anaesthesia after retrobulbar block with bupivacaine and lidocaine and sedation with midazolam and to point out that close monitoring and timely treatment is important in preventing an unfavourable outcome.
An 82-yr-old man with treated hypertension and stable angina was scheduled for cataract extraction. Physical examination revealed a class 2 airway. He had a retrobulbar block after topical tetracaine drops, with bupivacaine 0.5% and lidocaine 2% with hyaluronidase under sedation with 1 mg midazolam. Five minutes after the block, respiration slowed, he became unresponsive and oxygen saturation decreased to 80%. Immediate ventilation with mask without additional oxygen improved saturation. Attempted tracheal intubation failed: the epiglottis could not be visualized despite flaccid jaw and extremities. A laryngeal mask airway was placed which was leaking and adequate ventilation could not be achieved but a second laryngeal mask airway was placed successfully.
This case emphasizes the need for dose monitoring and personnel capable of managing the difficult airway when intra-orbital anaesthesia is used.
报告1例在布比卡因和利多卡因球后阻滞及咪达唑仑镇静后出现脑干麻醉导致插管困难的病例，并指出密切监测和及时治疗对于预防不良后果很重要。
一名82岁男性，有高血压治疗史和稳定型心绞痛，计划行白内障摘除术。体格检查显示气道分级为2级。在滴用丁卡因滴眼液表面麻醉后，给予0.5%布比卡因、2%利多卡因加透明质酸酶行球后阻滞，并静脉注射1mg咪达唑仑镇静。阻滞5分钟后，呼吸减慢，患者失去意识，血氧饱和度降至80%。立即面罩通气但未额外吸氧，饱和度有所改善。气管插管尝试失败：尽管下颌和四肢松弛，但仍无法看到会厌。放置了一个喉罩气道，但漏气，无法实现充分通气，随后成功放置了第二个喉罩气道。
该病例强调在使用眶内麻醉时，需要进行剂量监测并配备能够处理困难气道的人员。
