title: Cardiopulmonary arrest after retrobulbar anesthesia in a patient with an orbital roof defect.
abstract: OBJECTIVE
  Cardiopulmonary arrest developed after injection of bupivacaine hydrochloride, lidocaine, and hyaluronidase in a 78-year-old woman who had previously undergone ipsilateral transcranial orbital surgery with removal of the bone of the orbital roof.
  
  
  METHODS
  The patient required immediate cardiopulmonary resuscitation and intubation. Mechanical ventilation was necessary for 18 hours before spontaneous respirations resumed.
  
  
  RESULTS
  The patient improved and was discharged on the fifth postanesthetic day.
  
  
  CONCLUSIONS
  There were several possible mechanisms by which the local anesthetic could have entered the central nervous system. In patients with orbital roof defects, we recommend that retrobulbar anesthetic agents be used with caution.
authors.affiliation: Division of Ophthalmology, Saint Luke's Medical Center, Cleveland, OH 44104, USA.
authors.forename: D T
authors.initials: DT
authors.lastname: Weidenthal
authors.forename: J W
authors.initials: JW
authors.lastname: King
mesh_terms: D000368:Aged; D000772:Anesthesia, Local / Q000009:adverse effects; D000779:Anesthetics, Local / Q000009:adverse effects*; D002045:Bupivacaine / Q000009:adverse effects*; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000009:adverse effects*; D007442:Intubation, Intratracheal; D008012:Lidocaine / Q000009:adverse effects*; D009915:Orbit / Q000000981:diagnostic imaging / Q000601:surgery; D009916:Orbital Diseases / Q000150:complications / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014821:Vitrectomy
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D006821:Hyaluronoglucosaminidase; D002045:Bupivacaine