Brain Stem Anaesthesia Following Regional Anaesthesia for Cataract Surgery at ATeaching Hospital in Nigeria

Abstract

Regional block for ophthalmic anesthesia in cataract surgery is a long practice that is known to be safe and effective. However, the first rare life-threatening complication since the inception of the department, brain stem anesthesia is presented. Presented here is case ofa 70-year old male patient with bilateral dense cataracts in both eyes, blood pressure 120/85mmHg, regular full volume pulse, fasting blood sugar 5.4mmol/l and Hb 14g/dl was to have cataract surgery. Anesthetic nurse administered peribulbar anesthesia with 5 ml of xylocaine with adrenaline and hyalase using 25mm 21G needle, and at 5 minutes, full akinesia, and complete ptosis was achieved. The patient was, cleaned, and draped but suddenly became apneic, confused, and was not responding to command, BP was 85/35mmHg and pulse barely palpable 40/min. Immediate cardiac massage, secured airway, IV line with normal saline, and later alternate with dextrose saline was commenced. Consciousness deteriorated more, ambubaging was applied after 20 minutes, and consciousness improved, BP 90/40mmHg, volume stronger, apneas ceased and breathe 60 cycles per minutes. At 30 minutes BP was 110/80 mmHg, pulse 70/minutes better volume and the patient was beginning to obey command. The patient was transferred to the observation unit by next day patient was fully conscious with the return of vital signs to normal. Preventive and management measures must be put in place against this life threatening complication.