title: [Brainstem anesthesia with respiratory arrest after retrobulbar block--a case report with a review of literature].
abstract: BACKGROUND
  This case shows the time course and typical clinical features of brain stem anaesthesia. It is presumed that it follows accidental injection of local anaesthetic into the subarachnoidal space via the optic nerve sheaths.
  
  
  METHODS
  We report the case of a 70-year-old man, who became unconscious shortly after retrobulbar anaesthesia. The first symptoms developed after an interval of several minutes following the injection of the local anaesthetic. After the appearance of cranial nerves deficits the patient complained of difficulty breathing and became unconscious and apnoeic.
  
  
  RESULTS
  It was decided to intubate the patient. Heart rate and systolic blood pressure dropped, therefore, a central line was placed and intravenous fluids were given. The patient was brought to the intensive care unit where he was extubated uneventfully the same day.
  
  
  CONCLUSIONS
  The quick clinical recovery of the patient without any sequelae and the unremarkable results of internal and neurological examines support the diagnosis of brain stem anaesthesia.
authors.affiliation: Universitäts-Augenklinik, Ludwig Maximilians-Universität München. cschoen@ak-i.med.uni-muenchen.de
authors.forename: C L
authors.initials: CL
authors.lastname: Schönfeld
authors.forename: T
authors.initials: T
authors.lastname: Brinkschmidt
mesh_terms: D000368:Aged; D019162:Anesthetics, Combined / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D001933:Brain Stem / Q000187:drug effects*; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage; D007273:Injections, Intramuscular / Q000379:methods; D008297:Male; D019300:Medical Errors; D008619:Mepivacaine / Q000008:administration & dosage; D009801:Oculomotor Muscles; D012075:Remission, Spontaneous; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000139:chemically induced*; D013346:Subarachnoid Space / Q000187:drug effects / Q000293:injuries*
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008619:Mepivacaine; D006821:Hyaluronoglucosaminidase