眼科麻醉的并发症及其防治_West China Medical Journal

Authors：

 张雪荣 ,  罗俊

四川大学华西医院麻醉科（成都 610041）;

Corresponding author：

罗俊, Email: llljun@21cn.com

Keywords：

眼外科手手术; 麻醉; 并发症

DOI：

10.7507/1002-0179.20150398

Video：

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大多数眼外科手术在局部麻醉下即可完成，全身麻醉仅在少数情况下实施，由于眼部与血管、视神经和脑干等重要结构相毗邻，从而增加了手术和麻醉操作的风险。在所有的眼科麻醉并发症中，最严重的就是脑干麻醉，严重时可危及生命。因此，对于眼科麻醉的实施者来说，熟练掌握各项麻醉技术、预防麻醉并发症的发生尤为重要。以往眼科手术的麻醉主要由眼科医师自己实施，近年来随着眼科门诊手术中心手术量的日益增多，麻醉医师则越来越多地参与到眼科麻醉的实施和管理当中。通过回顾国内外文献资料的方法，对眼科麻醉的相关并发症进行分析总结，探讨如何对相关并发症进行识别、预防和处理，从而有效地减少和避免并发症的发生。

Citation： 张雪荣, 罗俊. 眼科麻醉的并发症及其防治. West China Medical Journal, 2015, 30(7): 1383-1386. doi: 10.7507/1002-0179.20150398 Copy

1.	El-Hindy N, Johnston RL, Jaycock P, et al. The Cataract National Dataset Electronic Multi-centre Audit of 55,567 operations:anaesthetic techniques and complications[J]. Eye (Lond), 2009, 23(1):50-55.
2.	王藜. 对眼科手术局部麻醉并发症的研究[J]. 世界最新医学信息文摘:电子版, 2013(16):74, 79.
3.	Riad W, Akbar F. Ophthalmic regional blockade complication rate:a single center audit of 33,363 ophthalmic operations[J]. J Clin Anesth, 2012, 24(3):193-195.
4.	王淑珍, 顾恩华, 张抗抗, 等. 颈部迷走神经阻滞预防眼心反射的临床研究[J]. 中华眼科杂志, 2010, 46(11):1016-1020.
5.	Vadivelu N, Huang Y, Kaye AD, et al. Prevention and management of complications of regional orbital anesthesia[J]. Middle East J Anaesthesiol, 2012, 21(6):775-784.
6.	Jaichandran V. Ophthalmic regional anaesthesia:a review and update[J]. Indian J Anaesth, 2013, 57(1):7-13.
7.	George RB, Hackett J. Bilateral hearing loss following a retrobulbar block[J]. Can J Anaesth, 2005, 52(10):1054-1057.
8.	Dahle JM, Iserson KV. ED treatment of brainstem anesthesia after retrobulbar block[J]. Am J Emerg Med, 2007, 25(1):105-106.
9.	Jaichandran VV, Nair AG, Gandhi RA, et al. Brainstem anesthesia presenting as contralateral third nerve palsy following peribulbar anesthesia for cataract surgery[J]. Acta Anaesthesiol Taiwan, 2013, 51(3):135-136.
10.	Kumar CM. Orbital regional anesthesia:complications and their prevention[J]. Indian J Ophthalmol, 2006, 54(2):77-84.
11.	Kumar CM, Dowd TC. Complications of ophthalmic regional blocks:their treatment and prevention[J]. Ophthalmologica, 2006, 220(2):73-82.
12.	Leibovitch I, Tamblyn D, Casson R, et al. Allergic reaction to hyaluronidase:a rare cause of orbital inflammation after cataract surgery[J]. Graefes Arch Clin Exp Ophthalmol, 2006, 244(8):944-949.
13.	Borchard K, Puy R, Nixon R. Hyaluronidase allergy:a rare cause of periorbital inflammation[J]. Australas J Dermatol, 2010, 51(1):49-51.
14.	Zamora-Alejo K, Moore S, Leatherbarrow B, et al. Hyaluronidase toxicity:a possible cause of postoperative periorbital inflammation[J]. Clin Experiment Ophthalmol, 2013, 41(2):122-126.
15.	Davis DB 2nd, Mandel MR. Effcacy and complication rate of 16,224 consecutive peribulbar blocks. A prospective multicenter study[J]. J Cataract Refract Surg, 1994, 20(3):327-337.
16.	Hamilton RC, Gimbel HV, Strunin L. Regional anesthesia for 12,000 cataract extraction and intraocular lens implantation procedures[J]. Can J Anaesth, 1988, 35(6):615-623.
17.	Duker JS, Belmont JB, Benson WE, et al. Inadvertent globe perforation during retrobulbar and peribulbar anesthesia. Patient characteristics, surgical management, and visual outcome[J]. Ophthalmology, 1991, 98(4):519-526.
18.	Edge R, Navon S. Scleral perforation during retrobulbar and peribulbar anesthesia:risk factors and outcomes in 50,000 consecutive injections[J]. J Cataract Refract Surg, 1999, 25(9):1237-1244.
19.	Vohra SB, Good PA. Altered globe dimensions of axial myopia as risk factors for penetrating ocular injury during peribulbar anaesthesia[J]. Br J Anaesth, 2000, 85(2):242-245.
20.	Hay A, Flynn HW Jr, Hoffman J, et al. Needle penetration of the globe during retrobulbar and peribulbar injections[J]. Ophthalmology, 1991, 98(7):1017-1024.
21.	Schneider ME, Milstein DE, Oyakawa RT, et al. Ocular perforation from a retrobulbar injection[J]. Am J Ophthalmol, 1988, 106(1):35-40.
22.	Parikh M, Kwon YH. Vision loss after inadvertent corneal perforation during lid anesthesia[J]. Ophthal Plast Reconstr Surg, 2011, 27(5):E141-E142.
23.	Spire M, Fleury J, Kodjikian L, et al. Retinal detachment caused by ocular perforation during periocular anesthesia:three case reports[J]. J Fr Ophtalmol, 2007, 30(6):e16.
24.	Berglin L, Stenkula S, Algvere PV. Ocular perforation during retrobulbar and peribulbar injections[J]. Ophthalmic Surg Lasers, 1995(26):429-434.
25.	Schrader WF, Schargus M, Schneider E, et al. Risks and sequelae of scleral perforation during peribulbar or retrobulbar anesthesia[J]. J Cataract Refract Surg, 2010, 36(6):885-889.
26.	Hamilton RC. A discourse on the complications of retrobulbar and peribulbar blockade[J]. Can J Ophthalmol, 2000, 35(7):363-372.
27.	Rubin AP. Complications of local anaesthesia for ophthalmic surgery[J]. Br J Anaesth, 1995, 75(1):93-96.
28.	Troll GF. Regional ophthalmic anesthesia:safe techniques and avoidance of complications[J]. J Clin Anesth, 1995, 7(2):163-172.
29.	Cyriac IC, Pineda R 2nd. Postoperative complications of periocular anesthesia[J]. Int Ophthalmol Clin, 2000, 40(1):85-91.
30.	Tsagkataki M, Rowlands A. Visual Loss due to non-arteritic anterior ischemic optic neuropathy (NAION) immediately following routine strabismus surgery under general anesthesia-a case report[J]. Strabismus, 2012, 20(3):121-123.
31.	Ascaso FJ. Transient central retinal artery occlusion following peribulbar anesthesia for pars plana vitrectomy[J]. J Clin Anesth, 2010, 22(7):577-578.
32.	Calenda E, Rey N, Compere V, et al. Peribulbar anesthesia leading to central retinal artery occlusion[J]. J Clin Anesth, 2009, 21(4):311-312.
33.	荣华,周晓东, 沈永明, 等. 球后麻醉致视网膜中央动脉阻塞一例[J]. 眼科研究, 2007, 25(1):77.
34.	Wong DH. Regional anaesthesia for intraocular surgery[J]. Can J Anaesth, 1993, 40(7):635-657.
35.	Capó H, Roth E, Johnson T, et al. Vertical strabismus after cataract surgery[J]. Ophthalmology, 1996, 103(6):918-921.
36.	Muralidhar R, Vijayalakshmi P, Gunda AK, et al. Inferior rectus paresis and medial rectus overaction following retrobulbar anesthesia for cataract surgery[J]. Int Ophthalmol, 2010, 30(4):435-438.
37.	Hunter DG, Lam GC, Guyton DL. Inferior oblique muscle injury from local anesthesia for cataract surgery[J]. Ophthalmology, 1995, 102(3):501-509.
38.	Blum RA, Lim LT, Weir CR. Diplopia following sub-tenon's anaesthesia:an unusual complication[J]. Int Ophthalmol, 2012, 32(2):191-193.
39.	Mehat MS, Sood V, Madge S. Blepharoptosis following anterior segment surgery:a new theory for an old problem[J]. Orbit, 2012, 31(4):274-278.
40.	Ropo A, Ruusuvaara P, Nikki P. Ptosis following periocular or general anaesthesia in cataract surgery[J]. Acta Ophthalmol (Copenh), 1992, 70(2):262-265.
41.	Alhassan MB, Kyari F, Ejere HO. Peribulbar versus retrobulbar anaesthesia for cataract surgery[J]. Cochrane Database Syst Rev, 2008, 16(3):CD004083.

1. El-Hindy N, Johnston RL, Jaycock P, et al. The Cataract National Dataset Electronic Multi-centre Audit of 55,567 operations:anaesthetic techniques and complications[J]. Eye (Lond), 2009, 23(1):50-55.
2. 王藜. 对眼科手术局部麻醉并发症的研究[J]. 世界最新医学信息文摘:电子版, 2013(16):74, 79.
3. Riad W, Akbar F. Ophthalmic regional blockade complication rate:a single center audit of 33,363 ophthalmic operations[J]. J Clin Anesth, 2012, 24(3):193-195.
4. 王淑珍, 顾恩华, 张抗抗, 等. 颈部迷走神经阻滞预防眼心反射的临床研究[J]. 中华眼科杂志, 2010, 46(11):1016-1020.
5. Vadivelu N, Huang Y, Kaye AD, et al. Prevention and management of complications of regional orbital anesthesia[J]. Middle East J Anaesthesiol, 2012, 21(6):775-784.
6. Jaichandran V. Ophthalmic regional anaesthesia:a review and update[J]. Indian J Anaesth, 2013, 57(1):7-13.
7. George RB, Hackett J. Bilateral hearing loss following a retrobulbar block[J]. Can J Anaesth, 2005, 52(10):1054-1057.
8. Dahle JM, Iserson KV. ED treatment of brainstem anesthesia after retrobulbar block[J]. Am J Emerg Med, 2007, 25(1):105-106.
9. Jaichandran VV, Nair AG, Gandhi RA, et al. Brainstem anesthesia presenting as contralateral third nerve palsy following peribulbar anesthesia for cataract surgery[J]. Acta Anaesthesiol Taiwan, 2013, 51(3):135-136.
10. Kumar CM. Orbital regional anesthesia:complications and their prevention[J]. Indian J Ophthalmol, 2006, 54(2):77-84.
11. Kumar CM, Dowd TC. Complications of ophthalmic regional blocks:their treatment and prevention[J]. Ophthalmologica, 2006, 220(2):73-82.
12. Leibovitch I, Tamblyn D, Casson R, et al. Allergic reaction to hyaluronidase:a rare cause of orbital inflammation after cataract surgery[J]. Graefes Arch Clin Exp Ophthalmol, 2006, 244(8):944-949.
13. Borchard K, Puy R, Nixon R. Hyaluronidase allergy:a rare cause of periorbital inflammation[J]. Australas J Dermatol, 2010, 51(1):49-51.
14. Zamora-Alejo K, Moore S, Leatherbarrow B, et al. Hyaluronidase toxicity:a possible cause of postoperative periorbital inflammation[J]. Clin Experiment Ophthalmol, 2013, 41(2):122-126.
15. Davis DB 2nd, Mandel MR. Effcacy and complication rate of 16,224 consecutive peribulbar blocks. A prospective multicenter study[J]. J Cataract Refract Surg, 1994, 20(3):327-337.
16. Hamilton RC, Gimbel HV, Strunin L. Regional anesthesia for 12,000 cataract extraction and intraocular lens implantation procedures[J]. Can J Anaesth, 1988, 35(6):615-623.
17. Duker JS, Belmont JB, Benson WE, et al. Inadvertent globe perforation during retrobulbar and peribulbar anesthesia. Patient characteristics, surgical management, and visual outcome[J]. Ophthalmology, 1991, 98(4):519-526.
18. Edge R, Navon S. Scleral perforation during retrobulbar and peribulbar anesthesia:risk factors and outcomes in 50,000 consecutive injections[J]. J Cataract Refract Surg, 1999, 25(9):1237-1244.
19. Vohra SB, Good PA. Altered globe dimensions of axial myopia as risk factors for penetrating ocular injury during peribulbar anaesthesia[J]. Br J Anaesth, 2000, 85(2):242-245.
20. Hay A, Flynn HW Jr, Hoffman J, et al. Needle penetration of the globe during retrobulbar and peribulbar injections[J]. Ophthalmology, 1991, 98(7):1017-1024.
21. Schneider ME, Milstein DE, Oyakawa RT, et al. Ocular perforation from a retrobulbar injection[J]. Am J Ophthalmol, 1988, 106(1):35-40.
22. Parikh M, Kwon YH. Vision loss after inadvertent corneal perforation during lid anesthesia[J]. Ophthal Plast Reconstr Surg, 2011, 27(5):E141-E142.
23. Spire M, Fleury J, Kodjikian L, et al. Retinal detachment caused by ocular perforation during periocular anesthesia:three case reports[J]. J Fr Ophtalmol, 2007, 30(6):e16.
24. Berglin L, Stenkula S, Algvere PV. Ocular perforation during retrobulbar and peribulbar injections[J]. Ophthalmic Surg Lasers, 1995(26):429-434.
25. Schrader WF, Schargus M, Schneider E, et al. Risks and sequelae of scleral perforation during peribulbar or retrobulbar anesthesia[J]. J Cataract Refract Surg, 2010, 36(6):885-889.
26. Hamilton RC. A discourse on the complications of retrobulbar and peribulbar blockade[J]. Can J Ophthalmol, 2000, 35(7):363-372.
27. Rubin AP. Complications of local anaesthesia for ophthalmic surgery[J]. Br J Anaesth, 1995, 75(1):93-96.
28. Troll GF. Regional ophthalmic anesthesia:safe techniques and avoidance of complications[J]. J Clin Anesth, 1995, 7(2):163-172.
29. Cyriac IC, Pineda R 2nd. Postoperative complications of periocular anesthesia[J]. Int Ophthalmol Clin, 2000, 40(1):85-91.
30. Tsagkataki M, Rowlands A. Visual Loss due to non-arteritic anterior ischemic optic neuropathy (NAION) immediately following routine strabismus surgery under general anesthesia-a case report[J]. Strabismus, 2012, 20(3):121-123.
31. Ascaso FJ. Transient central retinal artery occlusion following peribulbar anesthesia for pars plana vitrectomy[J]. J Clin Anesth, 2010, 22(7):577-578.
32. Calenda E, Rey N, Compere V, et al. Peribulbar anesthesia leading to central retinal artery occlusion[J]. J Clin Anesth, 2009, 21(4):311-312.
33. 荣华,周晓东, 沈永明, 等. 球后麻醉致视网膜中央动脉阻塞一例[J]. 眼科研究, 2007, 25(1):77.
34. Wong DH. Regional anaesthesia for intraocular surgery[J]. Can J Anaesth, 1993, 40(7):635-657.
35. Capó H, Roth E, Johnson T, et al. Vertical strabismus after cataract surgery[J]. Ophthalmology, 1996, 103(6):918-921.
36. Muralidhar R, Vijayalakshmi P, Gunda AK, et al. Inferior rectus paresis and medial rectus overaction following retrobulbar anesthesia for cataract surgery[J]. Int Ophthalmol, 2010, 30(4):435-438.
37. Hunter DG, Lam GC, Guyton DL. Inferior oblique muscle injury from local anesthesia for cataract surgery[J]. Ophthalmology, 1995, 102(3):501-509.
38. Blum RA, Lim LT, Weir CR. Diplopia following sub-tenon's anaesthesia:an unusual complication[J]. Int Ophthalmol, 2012, 32(2):191-193.
39. Mehat MS, Sood V, Madge S. Blepharoptosis following anterior segment surgery:a new theory for an old problem[J]. Orbit, 2012, 31(4):274-278.
40. Ropo A, Ruusuvaara P, Nikki P. Ptosis following periocular or general anaesthesia in cataract surgery[J]. Acta Ophthalmol (Copenh), 1992, 70(2):262-265.
41. Alhassan MB, Kyari F, Ejere HO. Peribulbar versus retrobulbar anaesthesia for cataract surgery[J]. Cochrane Database Syst Rev, 2008, 16(3):CD004083.

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眼科麻醉的并发症及其防治

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