[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.

History and signs: 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.

Therapy and outcome: 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.