Ophthalmic regional blocks: retrobulbar, peribulbar, sub-Tenon

Meet the patient

A 74-year-old receives a retrobulbar block for cataract surgery. Three minutes later he stops responding, and the saturation falls. The block was textbook; the orbit looks fine; the patient is simply not breathing.[1]

This is brainstem anaesthesia, and it is an airway emergency first, not an eye problem. The one question that decides his next thirty seconds is the only one that matters: are you ventilating him? Everything else — the block comparison, the anticoagulation logic, the canthotomy drill — builds on the reflex to oxygenate first when an eye-block patient goes quiet.[1]

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1. [1]Martyn JA, Richtsfeld M Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms Anesthesiology, 2006.PMID 16394702
2. [2]Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial Lancet, 2008.PMID 18479744
3. [3]Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery Circulation, 1999.PMID 10477528