title: Brainstem anaesthesia after retrobulbar block: a rare cause of coma presenting to the emergency department.
abstract: Local anaesthesia, in particular retrobulbar block, is commonly used to perform cataract surgery. Known complications of retrobulbar block include cranial nerve palsies, seizures and cardiorespiratory arrest. We report a case of brainstem anaesthesia causing apnoea and loss of consciousness in a man who received retrobulbar block. The likely mechanism is inadvertent dural puncture of the optic nerve sheath and local anaesthetic injection into the cerebrospinal fluid space. As in this case, the literature reports a short-lived period of anaesthesia with usually no long-term sequelae. Although rare, it is a life-threatening complication if the patient is not appropriately resuscitated. This case highlights the need for trained personnel, with suitable monitoring and adequate resuscitation facilities in order to perform this technique.
authors.affiliation: Department of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia. naren_gunja@wsahs.nsw.gov.au
authors.forename: Naren
authors.initials: N
authors.lastname: Gunja
authors.forename: Kavita
authors.initials: K
authors.lastname: Varshney
mesh_terms: D000368:Aged; D000779:Anesthetics, Local; D001933:Brain Stem / Q000187:drug effects*; D002045:Bupivacaine; D002387:Cataract Extraction; D003128:Coma / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004635:Emergency Medicine / Q000379:methods; D004636:Emergency Service, Hospital; D015600:Glasgow Coma Scale; D006801:Humans; D008012:Lidocaine; D008297:Male; D009407:Nerve Block / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine