Generalized seizures and transient contralateral hemiparesis following retrobulbar anesthesia: a case report. 2015

Maria Dettoraki, and Chrisafoula Dimitropoulou, and Nikolaos Nomikarios, and Marilita M Moschos, and Dimitrios Brοuzas
1st Department of Ophthalmology, University of Athens, "G. Gennimatas" General Hospital of Athens, 10 G. Papandreou Str, Byron, Athens, 16231, Greece.

BACKGROUND Retrobulbar block is a local anesthetic technique widely used for intraocular surgery. Although retrobulbar anesthesia is considered to be relatively safe, a number of serious adverse events have been reported. To our knowledge, immediate onset of generalized seizures with contralateral hemiparesis after retrobulbar anesthesia has not been reported. METHODS A 62-year-old Caucasian healthy male with a right eye retinal detachment was admitted for pars plana vitrectomy. During retrobulbar anesthesia with ropivacaine and before needle withdrawal, the patient developed twitching of the face which rapidly progressed to generalized tonic-clonic seizures. Arterial oxygen saturation decreased to 75 %. Chin lift was performed and 100 % oxygen was administrated via face mask, which increased saturation to 99 %. Midazolam 2 mg was administrated intravenously to control seizures. After cessation of seizures, left-sided hemiparesis was evident. Brain computed tomography and electroencephalogram were normal 3 h later. The patient underwent pars plana vitrectomy under general anesthesia 4 days later. CONCLUSIONS Serious complications of local anesthesia for ophthalmic surgery are uncommon. We present a case in which generalized tonic-clonic seizures developed during retrobulbar anesthesia, followed by transient contralateral hemiparesis. The early onset of seizures indicated intra-arterial injection of the anesthetic. Our case suggested the need for close monitoring during the performance of retrobulbar anesthesia and the presence of well-trained personnel for early recognition and immediate management of the complications.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009407 Nerve Block Interruption of NEURAL CONDUCTION in peripheral nerves or nerve trunks by the injection of a local anesthetic agent (e.g., LIDOCAINE; PHENOL; BOTULINUM TOXINS) to manage or treat pain. Chemical Neurolysis,Chemodenervation,Nerve Blockade,Block, Nerve,Blockade, Nerve,Blockades, Nerve,Blocks, Nerve,Chemical Neurolyses,Chemodenervations,Nerve Blockades,Nerve Blocks,Neurolyses, Chemical,Neurolysis, Chemical
D010100 Oxygen An element with atomic symbol O, atomic number 8, and atomic weight [15.99903; 15.99977]. It is the most abundant element on earth and essential for respiration. Dioxygen,Oxygen-16,Oxygen 16
D010291 Paresis A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for PARALYSIS (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis (see NEUROSYPHILIS). "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as PARAPARESIS. Hemiparesis,Muscle Paresis,Brachial Paresis,Crural Paresis,Lower Extremity Paresis,Monoparesis,Muscular Paresis,Upper Extremity Paresis,Brachial Pareses,Crural Pareses,Extremity Pareses, Lower,Extremity Pareses, Upper,Extremity Paresis, Lower,Extremity Paresis, Upper,Hemipareses,Lower Extremity Pareses,Monopareses,Muscle Pareses,Muscular Pareses,Pareses,Pareses, Brachial,Pareses, Crural,Pareses, Lower Extremity,Pareses, Muscle,Pareses, Muscular,Pareses, Upper Extremity,Paresis, Brachial,Paresis, Crural,Paresis, Lower Extremity,Paresis, Muscle,Paresis, Muscular,Paresis, Upper Extremity,Upper Extremity Pareses
D012163 Retinal Detachment Separation of the inner layers of the retina (neural retina) from the pigment epithelium. Retinal detachment occurs more commonly in men than in women, in eyes with degenerative myopia, in aging and in aphakia. It may occur after an uncomplicated cataract extraction, but it is seen more often if vitreous humor has been lost during surgery. (Dorland, 27th ed; Newell, Ophthalmology: Principles and Concepts, 7th ed, p310-12). Retinal Pigment Epithelial Detachment,Detachment, Retinal,Detachments, Retinal,Retinal Detachments
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000772 Anesthesia, Local A blocking of nerve conduction to a specific area by an injection of an anesthetic agent. Anesthesia, Infiltration,Local Anesthesia,Neural Therapy of Huneke,Huneke Neural Therapy,Infiltration Anesthesia
D000779 Anesthetics, Local Drugs that block nerve conduction when applied locally to nerve tissue in appropriate concentrations. They act on any part of the nervous system and on every type of nerve fiber. In contact with a nerve trunk, these anesthetics can cause both sensory and motor paralysis in the innervated area. Their action is completely reversible. (From Gilman AG, et. al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed) Nearly all local anesthetics act by reducing the tendency of voltage-dependent sodium channels to activate. Anesthetics, Conduction-Blocking,Conduction-Blocking Anesthetics,Local Anesthetic,Anesthetics, Topical,Anesthetic, Local,Anesthetics, Conduction Blocking,Conduction Blocking Anesthetics,Local Anesthetics,Topical Anesthetics
D012640 Seizures Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as EPILEPSY or "seizure disorder." Absence Seizure,Absence Seizures,Atonic Absence Seizure,Atonic Seizure,Clonic Seizure,Complex Partial Seizure,Convulsion,Convulsions,Convulsive Seizure,Convulsive Seizures,Epileptic Seizure,Epileptic Seizures,Generalized Absence Seizure,Generalized Tonic-Clonic Seizures,Jacksonian Seizure,Myoclonic Seizure,Non-Epileptic Seizure,Nonepileptic Seizure,Partial Seizure,Seizure,Seizures, Convulsive,Seizures, Focal,Seizures, Generalized,Seizures, Motor,Seizures, Sensory,Tonic Clonic Seizure,Tonic Seizure,Tonic-Clonic Seizure,Atonic Absence Seizures,Atonic Seizures,Clonic Seizures,Complex Partial Seizures,Convulsion, Non-Epileptic,Generalized Absence Seizures,Myoclonic Seizures,Non-Epileptic Seizures,Nonepileptic Seizures,Partial Seizures,Petit Mal Convulsion,Seizures, Auditory,Seizures, Clonic,Seizures, Epileptic,Seizures, Gustatory,Seizures, Olfactory,Seizures, Somatosensory,Seizures, Tonic,Seizures, Tonic-Clonic,Seizures, Vertiginous,Seizures, Vestibular,Seizures, Visual,Single Seizure,Tonic Seizures,Tonic-Clonic Seizures,Absence Seizure, Atonic,Absence Seizure, Generalized,Absence Seizures, Atonic,Absence Seizures, Generalized,Auditory Seizure,Auditory Seizures,Clonic Seizure, Tonic,Clonic Seizures, Tonic,Convulsion, Non Epileptic,Convulsion, Petit Mal,Convulsions, Non-Epileptic,Focal Seizure,Focal Seizures,Generalized Seizure,Generalized Seizures,Generalized Tonic Clonic Seizures,Generalized Tonic-Clonic Seizure,Gustatory Seizure,Gustatory Seizures,Motor Seizure,Motor Seizures,Non Epileptic Seizure,Non Epileptic Seizures,Non-Epileptic Convulsion,Non-Epileptic Convulsions,Olfactory Seizure,Olfactory Seizures,Partial Seizure, Complex,Partial Seizures, Complex,Seizure, Absence,Seizure, Atonic,Seizure, Atonic Absence,Seizure, Auditory,Seizure, Clonic,Seizure, Complex Partial,Seizure, Convulsive,Seizure, Epileptic,Seizure, Focal,Seizure, Generalized,Seizure, Generalized Absence,Seizure, Generalized Tonic-Clonic,Seizure, Gustatory,Seizure, Jacksonian,Seizure, Motor,Seizure, Myoclonic,Seizure, Non-Epileptic,Seizure, Nonepileptic,Seizure, Olfactory,Seizure, Partial,Seizure, Sensory,Seizure, Single,Seizure, Somatosensory,Seizure, Tonic,Seizure, Tonic Clonic,Seizure, Tonic-Clonic,Seizure, Vertiginous,Seizure, Vestibular,Seizure, Visual,Seizures, Generalized Tonic-Clonic,Seizures, Nonepileptic,Sensory Seizure,Sensory Seizures,Single Seizures,Somatosensory Seizure,Somatosensory Seizures,Tonic Clonic Seizures,Tonic-Clonic Seizure, Generalized,Tonic-Clonic Seizures, Generalized,Vertiginous Seizure,Vertiginous Seizures,Vestibular Seizure,Vestibular Seizures,Visual Seizure,Visual Seizures

Related Publications

Maria Dettoraki, and Chrisafoula Dimitropoulou, and Nikolaos Nomikarios, and Marilita M Moschos, and Dimitrios Brοuzas
February 2003, American journal of ophthalmology,
Maria Dettoraki, and Chrisafoula Dimitropoulou, and Nikolaos Nomikarios, and Marilita M Moschos, and Dimitrios Brοuzas
June 1985, Endodontics & dental traumatology,
Maria Dettoraki, and Chrisafoula Dimitropoulou, and Nikolaos Nomikarios, and Marilita M Moschos, and Dimitrios Brοuzas
January 2006, Regional anesthesia and pain medicine,
Maria Dettoraki, and Chrisafoula Dimitropoulou, and Nikolaos Nomikarios, and Marilita M Moschos, and Dimitrios Brοuzas
February 1996, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie,
Maria Dettoraki, and Chrisafoula Dimitropoulou, and Nikolaos Nomikarios, and Marilita M Moschos, and Dimitrios Brοuzas
April 1986, Ophthalmology,
Maria Dettoraki, and Chrisafoula Dimitropoulou, and Nikolaos Nomikarios, and Marilita M Moschos, and Dimitrios Brοuzas
January 1982, Journal of neurology,
Maria Dettoraki, and Chrisafoula Dimitropoulou, and Nikolaos Nomikarios, and Marilita M Moschos, and Dimitrios Brοuzas
February 1990, Annals of ophthalmology,
Maria Dettoraki, and Chrisafoula Dimitropoulou, and Nikolaos Nomikarios, and Marilita M Moschos, and Dimitrios Brοuzas
January 2017, GMS ophthalmology cases,
Maria Dettoraki, and Chrisafoula Dimitropoulou, and Nikolaos Nomikarios, and Marilita M Moschos, and Dimitrios Brοuzas
November 2022, World journal of clinical cases,
Maria Dettoraki, and Chrisafoula Dimitropoulou, and Nikolaos Nomikarios, and Marilita M Moschos, and Dimitrios Brοuzas
September 1983, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde,
Copied contents to your clipboard!