Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2022; 10(31): 11646-11651
Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11646
Apnea caused by retrobulbar anesthesia: A case report
Yue-Lin Wang, Guo-Ru Lan, Xuan Zou, Er-Qian Wang, Rong-Ping Dai, You-Xin Chen
Yue-Lin Wang, Guo-Ru Lan, Xuan Zou, Er-Qian Wang, Rong-Ping Dai, You-Xin Chen, Department of Ophthalmology, Peking Union Medical College Hospital, Beijing 100730, China
Author contributions: Wang YL, Zou X, Wang EQ, and Dai RP were involved in the patient’s diagnosis and treatment; Lan GR contributed to the manuscript revision; Chen YX and Dai RP contributed to the image evaluation and manuscript revision; All authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: You-Xin Chen, MD, PhD, Professor, Department of Ophthalmology, Peking Union Medical College Hospital, No. 1 Shuaifu Garden, Dongcheng District, Beijing 100730, China. chenyx@pumch.cn
Received: July 27, 2022
Peer-review started: July 27, 2022
First decision: August 22, 2022
Revised: September 5, 2022
Accepted: September 29, 2022
Article in press: September 29, 2022
Published online: November 6, 2022
Processing time: 91 Days and 22.1 Hours
Abstract
BACKGROUND

Apnea caused by retrobulbar anesthesia is a very rare but severe complication during ophthalmic surgery.

CASE SUMMARY

We report a rare case of apnea caused by retrobulbar anesthesia, and emergency resuscitation was used. A 74-year-old female patient was diagnosed with rhegmatogenous retinal detachment in the right eye and planned to undergo vitrectomy under retrobulbar anesthesia. After the retrobulbar anesthesia in her right eye, she became unconscious and apneic. It was suggested that she had developed brainstem anesthesia. Assisted ventilation was initiated. Atropine 0.5 mg, epinephrine 1 mg, ephedrine 30 mg, and lipid emulsion were given. Five minutes later, her consciousness and breathing gradually returned, but with uncertain light perception in her right eye. Alprostadil 20 µg was given, and after 2 h her visual acuity resumed to the preoperative level.

CONCLUSION

Brainstem anesthesia is a serious complication secondary to retrobulbar anesthesia. Medical staff should pay attention to the identification of brainstem anesthesia and be familiar with the emergency treatment for this complication.

Keywords: Apnea; Retrobulbar anesthesia; Brainstem anesthesia; Ophthalmic surgery; Case report

Core Tip: Apnea caused by retrobulbar anesthesia is a very rare but severe complication. Failure to recognize brainstem anesthesia or delaying the treatment may be life threatening. We report a rare case of apnea caused by retrobulbar anesthesia, and emergency resuscitation was used. Assisted ventilation and vasodilator treatment were used, and the consciousness and breathing of the patient was gradually recovered. The mechanism of retrobulbar anesthesia is varied, but a skillful operation of retrobulbar anesthesia is important. Doctors and nurses should be aware of the potential risk of retrobulbar anesthesia, and be familiar with the resuscitation procedures.