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Chandrasekaran PR, Aziz AA, Khan H, Khanani AM. Cooling Anesthesia for Intravitreal Injections - A Review. Clin Ophthalmol 2023; 17:197-207. [PMID: 36660308 PMCID: PMC9844145 DOI: 10.2147/opth.s388327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/11/2022] [Indexed: 01/15/2023] Open
Abstract
Intravitreal (IVT) injections are the most common procedure performed in retinal clinics today. It has revolutionized the treatment of neovascular age-related macular degeneration (nAMD), diabetic macular edema, macular edema due to veinous occlusive disease and other forms of exudative maculopathy. Though IVT injections prevent vision loss, the discomfort at the time of the injection has been troublesome to patients. This has led to patients missing their regular and routine dosage of treatment. Various modes of pre-injection anesthetic methods have been tried but in vain. Lidocaine-based topical anesthesia, in the form of pledgets, topical gel or subconjunctival lidocaine injection, has been the standard of care (SOC) for IVT injections worldwide. This article highlights the role of cooling anesthesia in reducing pain, anxiety and discomfort associated with needle penetration at the time of injection. PubMed and MedLine search were related to anesthesia for intravitreal injections, cooling anesthesia, mechanism of cooling anesthesia, COOL-1 trial, COOL-2 trial, results of COOL-1 trial and ultrarapid cooling anesthesia.
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Affiliation(s)
- Priya R Chandrasekaran
- Department of Medical Retina, Uvea and Neuro-Ophthalmology, Lotus Eye Hospital, Salem, Tamil Nadu, India
| | - Aamir A Aziz
- University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Hannah Khan
- University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Arshad M Khanani
- University of Nevada, Reno School of Medicine, Reno, NV, USA,Sierra Eye Associates, Reno, NV, USA,Correspondence: Arshad M Khanani, Email
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Anesthesia for ophthalmic surgery: an educational review. Int Ophthalmol 2022; 43:1761-1769. [PMID: 36436168 DOI: 10.1007/s10792-022-02564-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/16/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Selecting an anesthetic agent for ophthalmic surgery has crucial implications for the surgeon, anesthesiologist, and patient. This educational review explores the common classes of anesthesia used in ophthalmology. Additionally, we discuss the considerations unique to cataract, glaucoma, strabismus, orbital, oculoplastic, and ocular trauma surgeries. METHODS A comprehensive Embase search was performed using combinations of the subject headings "anesthesia", "eye surgery", "ophthalmology" and "cataract extraction", "glaucoma", "strabismus", "vitreoretinal surgery", "retina surgery", "eye injury", and "eyelid reconstruction". RESULTS Topical anesthetics are the most commonly used form of ocular anesthesia, used in both an office and surgical setting, and carry a minimal side effect profile. Notably, topical anesthetics offer analgesia, but do not provide akinesia or amnesia. Regional blocks, such as are sub-Tenon's, peribulbar, and retrobulbar blocks, are used when akinesia is required in addition to analgesia. Recently, sub-Tenon's blocks have recently gained popularity due to their improved safety profile compared to other regional blocks. General anesthesia is considered for long, complex surgery, surgery in patients with multiple comorbidities, surgery in young pediatric patients, or surgery in patients intolerant to local or regional anesthetic. CONCLUSION Anesthetizing the eye has rapidly evolved in recent years, supporting the safety, efficacy and comfort of ocular surgery. Since there are many viable options of anesthetics available for ophthalmic surgery, a robust understanding of the patients needs, the skill of the surgical team, and surgery-specific factors ought to be considered when creating an anesthetic plan for surgery.
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Xu Q, Ren M, Guan J, Shi G, Ni Y, Luan J. Efficacy and safety of trans-sub-Tenon's retrobulbar anesthesia for pars plana vitrectomy: a randomized trial. BMC Ophthalmol 2022; 22:289. [PMID: 35773662 PMCID: PMC9248172 DOI: 10.1186/s12886-022-02507-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
AIM To compare the efficacy and safety of trans-sub-Tenon's ciliary nerve block anesthesia and transcutaneous retrobulbar anesthesia in patients undergoing pars plana vitrectomy (PPV). METHODS A prospective, randomized, double-blinded clinical trial was conducted at Zhongda Hospital, Affiliated with Southeast University, from February 2021 to October 2021. Patients undergoing PPV were randomly allocated into two groups: the trans-sub-Tenon's anesthesia group (ST group) and the retrobulbar anesthesia group (RB group) in the ratio of 1:1. The ST group received 2 ml ropivacaine through the Tenon capsule to the retrobulbar space, while the RB group received 2 ml ropivacaine via transcutaneous retrobulbar injection. Visual analog score (VAS) was used to evaluate pain during the whole process, including during anesthesia implementation, intraoperatively and on the first day after the operation. Movement evaluation (Brahma scores) and anesthesia-related complications were also noted. RESULTS Finally, a total of 120 patients were included in the study (60 in the ST group and 60 in the RB group). There were no significant differences in baseline patient characteristics or surgical features between the two groups. The VAS pain scores for anesthesia implementation were 0.52 ± 0.47 in the ST group and 1.83 ± 0.87 in the RB group (P < 0.001). The VAS scores during the operation were 0.53 ± 0.49 in the ST group and 1.48 ± 1.02 in the RB group (P < 0.001) and those on the first day after the operation were 0.37 ± 0.38 in the ST group and 0.81 ± 0.80 in the RB group (P = 0.002). No patients required supplemental intravenous anesthesia intraoperatively. The Brahma movement scores were 0.70 ± 1.64 in the ST group (scores ranging from 0 to 8) and 2.38 ± 3.15 in the RB group (ranging from 0 to 12) (P = 0.001). Forty-two patients in each group received laser photocoagulation during surgery. Fifteen patients (36%) in the ST group could not see the flashes of the laser, compared to 8 patients (19%) in the RB group (P = 0.087). No serious sight-threatening or life-threatening complications related to anesthesia were observed in either group. CONCLUSIONS For PPV, trans-sub-Tenon's ciliary nerve block anesthesia was more effective in controlling pain than transcutaneous retrobulbar anesthesia during the whole surgery process, including during anesthesia implementation, intraoperatively and on the first day after the operation. Additionally, it could achieve better effect of akinesia and was relatively safe. Trans-sub-Tenon's anesthesia could be considered an alternative form of local anesthesia during vitreoretinal procedures. TRIAL REGISTRATION The study protocol has been registered at ChiCTR.org.cn on February 2021 under the number ChiCTR2100043109 .
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Affiliation(s)
- Qian Xu
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, China.,School of Medicine, Southeast University, Nanjing, 210009, China
| | - Meiqing Ren
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, China.,School of Medicine, Southeast University, Nanjing, 210009, China
| | - Juanjuan Guan
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, China
| | - Guihong Shi
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, China
| | - Yan Ni
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, China
| | - Jie Luan
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, China. .,School of Medicine, Southeast University, Nanjing, 210009, China.
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Percutaneous infracaruncular approach with minimal volume of lidocaine in ocular anaesthesia. Anaesth Crit Care Pain Med 2021; 40:100973. [PMID: 34773917 DOI: 10.1016/j.accpm.2021.100973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/18/2021] [Accepted: 07/23/2021] [Indexed: 11/22/2022]
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Ribeiro JAS, Ribeiro DS, Scott IU, Abrão J, Jorge R. Pain during pars plana vitrectomy following sub-Tenon versus peribulbar anesthesia: A randomized trial. PLoS One 2020; 15:e0236624. [PMID: 32760093 PMCID: PMC7410239 DOI: 10.1371/journal.pone.0236624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/03/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To compare pain during pars plana vitrectomy (PPV) following topical lidocaine jelly and sub-Tenon anesthesia versus peribulbar anesthesia. Methods Prospective, single-center, randomized study. Patients scheduled for PPV for macular hole (MH) or epiretinal membrane (ERM) at the Retina and Vitreous Section of the Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo were randomly assigned to one of two groups in a 1:1 allocation ratio. Patients assigned to Group ST received topical anesthesia with 2% lidocaine jelly followed by sub-Tenon anesthesia with 2–4 ml of 1% ropivacaine. Patients assigned to PB received peribulbar anesthesia with 4–6 ml of 1% ropivacaine. After PPV, patients in both groups were asked to rate the level of pain they felt during the entire procedure (including anesthesia administration and PPV) by pointing at a 0–100 Visual Analogue Pain Scale (VAS). Data regarding demographics, patient characteristics and surgical features were also collected. Results Fifty-four patients were enrolled in the study (26 in Group ST and 28 in Group PB). Baseline characteristics, including age, gender, and presence of comorbidities, were similar in both groups. The surgery performed was PPV alone in 10 and 14 patients in the ST and PB groups, respectively, and combined phacoemulsification and PPV in 16 and 14 patients in the ST and PB groups, respectively (p = 0.39, Pearson). Surgery duration (mean ± SD minutes) was similar in the two groups (62 ± 12 for ST and 70 ± 20 for PB, p = 0.09, t-Test). No patients needed supplemental topical or intravenous anesthesia during surgery. No sight- or life-threatening complication was observed in either group. VAS score was significantly lower in the ST compared to the PB group (median (interquartile range) was 1 (2.25–0) in the ST group compared to 11.5 (29.75–5) in the PB group, p< 0.0001, Wilcoxon). Conclusion In this study of patients who underwent PPV for MH or ERM, topical followed by sub-Tenon anesthesia was more effective in controlling pain during the whole vitrectomy procedure than peribulbar anesthesia. Compared to peribulbar anesthesia which is administered with a sharp needle, sub-Tenon anesthesia administered with a blunt cannula may be associated with a reduced risk of such adverse events as globe perforation, retrobulbar hemorrhage, and inadvertent injection of anesthesia into the optic nerve sheath.
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Affiliation(s)
- Jefferson A. S. Ribeiro
- Superior School of Health Sciences, Amazonas State University, Manaus, AM, Brazil
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- * E-mail:
| | - Daniel S. Ribeiro
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ingrid U. Scott
- Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - João Abrão
- Department of Biomechanics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Rodrigo Jorge
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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Han J, Rinella NT, Chao DL. Anesthesia for Intravitreal Injection: A Systematic Review. Clin Ophthalmol 2020; 14:543-550. [PMID: 32161439 PMCID: PMC7049779 DOI: 10.2147/opth.s223530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/19/2019] [Indexed: 01/26/2023] Open
Abstract
Background The intravitreal injection has become one of the most commonly performed procedures in ophthalmology; however, there is no standardized approach to anesthesia during the procedure. The goal of this systematic review is to review approaches to anesthesia for intravitreal injection and look at comparative efficacy between these different anesthetics. Methods A systematic review of literature was performed in the MEDLINE, PubMed, Cochrane Library, and Clinicaltrials.gov databases using the key words “anesthesia”, “pain management”, and “intravitreal injection”. Of the initial 239 search matches, 30 articles were found to be relevant to the topic. 18 studies were excluded as they did not include primary data or did not include the visual analog scale as a primary outcome. The remaining 12 articles were assessed to look at the comparative efficacy of anesthesia and adverse events. Results The anesthesia techniques reported include topical methods such as anesthetic eyedrops, anesthetic gels, and anesthetic-soaked pledgets as well as subconjunctival injection of anesthetic. Ultimately, no single anesthetic or delivery mechanism was shown to be superior to the others in a statistically significant way and adverse events were largely insignificant. Limitations of these studies include relatively small sizes of the studies, as well as the lack of masking which may introduce bias. Conclusion In the current literature, no type of anesthetic method was found to be superior to another for intravitreal injection. Future studies in this area may lead to new insights into the efficacy of different forms of intravitreal anesthesia.
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Affiliation(s)
- Jonathan Han
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, USA
| | - Nicholas T Rinella
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, USA
| | - Daniel L Chao
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, USA
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Woodruff AG, Santamaria CM, Mehta M, Pemberton GL, Cullion K, Kohane DS. Prolonged Duration Topical Corneal Anesthesia With the Cationic Lidocaine Derivative QX-314. Transl Vis Sci Technol 2019; 8:28. [PMID: 31637108 PMCID: PMC6798327 DOI: 10.1167/tvst.8.5.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/15/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Topical corneal local anesthetics are short acting and may impair corneal healing. In this study we compared corneal anesthesia and toxicity of topically applied N-ethyl lidocaine (QX-314) versus the conventional local anesthetic, proparacaine (PPC). Methods Various concentrations of QX-314 and 15 mM (0.5%) PPC were topically applied to rat corneas. Corneal anesthesia was assessed with a Cochet-Bonnet esthesiometer at predetermined time points. PC12 cells were exposed to the same solutions to assess cytotoxicity. Repeated topical corneal administration in rats was then used to assess for histologic evidence of toxicity. Finally, we created uniform corneal epithelial defects in rats and assessed the effect of repeated administration of these compounds on the defect healing rate. Results QX-314 (15 mM) and PPC (15 mM) caused similar total duration (114 ± 17 and 87 ± 16 minutes, respectively; P = 0.06) of anesthesia. The depth of anesthesia was similar between these low-dose groups at 15 minutes after application (1.8 ± 0.3- and 2.0 ± 0.8-cm filament lengths). QX-314 (100 mM) provided more prolonged corneal anesthesia (174 ± 13 minutes; P < 0.0001), with improved depth at 15 minutes (0.7 ± 0.3-cm filament length; P = 0.007). All tested concentrations of QX-314 demonstrated similar or less toxicity than 0.5% PPC. Conclusions Topical administration of QX-314 is effective for corneal anesthesia and demonstrates no histologic signs of local toxicity in a rodent model. In higher concentrations, QX-314 provides more than twofold the duration of anesthetic effect than does 0.5% PPC. Translational Relevance Our study reveals a clinically relevant compound providing prolonged duration topical corneal anesthesia.
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Affiliation(s)
- Alan G Woodruff
- Kohane Lab for Biomaterials and Drug Delivery, Department of Anesthesia, Perioperative and Pain Medicine, Division of Critical Care, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Claudia M Santamaria
- Kohane Lab for Biomaterials and Drug Delivery, Department of Anesthesia, Perioperative and Pain Medicine, Division of Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Manisha Mehta
- Kohane Lab for Biomaterials and Drug Delivery, Department of Anesthesia, Perioperative and Pain Medicine, Division of Critical Care, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Grant L Pemberton
- Kohane Lab for Biomaterials and Drug Delivery, Department of Anesthesia, Perioperative and Pain Medicine, Division of Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Kathleen Cullion
- Kohane Lab for Biomaterials and Drug Delivery, Department of Anesthesia, Perioperative and Pain Medicine, Division of Critical Care, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of Medicine Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel S Kohane
- Kohane Lab for Biomaterials and Drug Delivery, Department of Anesthesia, Perioperative and Pain Medicine, Division of Critical Care, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,David H. Koch Institute, Massachusetts Institute of Technology, Cambridge, MA, USA
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Chen WQ, Jhanji V, Chen HY, Zhang GH, Hou P. Visual impact of sub-Tenon anesthesia during combined phacoemulsification and vitrectomy surgery. Int J Ophthalmol 2014; 7:860-3. [PMID: 25349807 DOI: 10.3980/j.issn.2222-3959.2014.05.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/02/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To investigate the visual impact of sub-Tenon anesthesia during combined phacoemulsification and vitrectomy surgery. METHODS In this prospective case series, consecutive patients who underwent combined phacoemulsification and pars plana vitrectomy (PPV) under sub-Tenon anesthesia between October 2008 and September 2009 were enrolled. The patients were asked whether they could see the light of the operating microscope or not between various surgical steps with their contralateral eye being covered. RESULTS A total of 163 eyes of 163 patients were enrolled in this study. After their contralateral eyes were covered, 152 (93.3%) patients said that they could not see any light at least during one of the surgical steps. All eyes recovered to at least light perception on the first postoperative day. The incidence of no light perception during the surgery was not related to demographic factors, including age, gender, or type of ocular diseases. CONCLUSION The incidence of no light perception during combined phacoemulsification and vitrectomy under sub-Tenon anesthesia was high in our study. Patients should be duly informed about this temporary but potential intraoperative event.
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Affiliation(s)
- Wei-Qi Chen
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou 515041, Guangdong Province, China
| | - Vishal Jhanji
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou 515041, Guangdong Province, China ; Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
| | - Hao-Yu Chen
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou 515041, Guangdong Province, China
| | - Gui-Hua Zhang
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou 515041, Guangdong Province, China
| | - Ping Hou
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou 515041, Guangdong Province, China
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McCloud C, Harrington A, King L. A qualitative study of regional anaesthesia for vitreo-retinal surgery. J Adv Nurs 2013; 70:1094-104. [PMID: 24102774 DOI: 10.1111/jan.12263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2013] [Indexed: 11/30/2022]
Abstract
AIM The aim of this research was to collect experiential knowledge about regional ocular anaesthesia - an integral component of most vitreo-retinal surgery. BACKGROUND Anaesthesia for vitreo-retinal surgery has predominantly used general anaesthesia, because of the length and complexity of the surgical procedure. However, recent advances in surgical instrumentation and techniques have reduced surgical times; this decision has led to the adoption of regional ocular anaesthesia for vitreo-retinal day surgery. Although regional ocular anaesthesia has been studied from several perspectives, knowledge about patients' experience of the procedure is limited. DESIGN An interpretive qualitative research methodology underpinned by Gadamer's philosophical hermeneutics. METHODS Eighteen participants were interviewed in-depth between July 2006-December 2007 following regional ocular anaesthesia. Interview data were thematically analysed by coding and grouping concepts. FINDINGS Four themes were identified: 'not knowing': the time prior to the experience of a regional eye block; 'experiencing': the experience of regional ocular anaesthesia; 'enduring': the capacity participants displayed to endure regional ocular anaesthesia with the hope that their vision would be restored; and 'knowing': when further surgery was required and past experiences were recalled. CONCLUSIONS The experience of regional ocular anaesthesia had the capacity to invoke anxiety in the participants in this study. Many found the experience overwhelming and painful. What became clear was the participant's capacity to stoically 'endure' regional ocular anaesthesia, indicating the value people placed on visual function.
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Affiliation(s)
- Christine McCloud
- School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia
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Pucket JD, Allbaugh RA, Rankin AJ, Ou Z, Bello NM. Comparison of efficacy and duration of effect on corneal sensitivity among anesthetic agents following ocular administration in clinically normal horses. Am J Vet Res 2013; 74:459-64. [DOI: 10.2460/ajvr.74.3.459] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Khanna AK, Cummings KC. Pulmonary hemorrhage in an outpatient ophthalmic anesthesia setting - it's never "just a cataract". J Anaesthesiol Clin Pharmacol 2012; 28:520-3. [PMID: 23225939 PMCID: PMC3511956 DOI: 10.4103/0970-9185.101947] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 48-year-old man, with end stage renal disease and a history of recreational drug abuse, presented for elective cataract surgery. Patient underwent the procedure with a general endotracheal anesthesia with a balanced anesthetic. After an uneventful intra-operative period, he had a sudden onset large volume hemoptysis just prior to extubation. Poor oxygenation and hemodynamic instability necessitated emergent reintubation in the immediate post-extubation period. Emergent bronchoscopy did not show active airway bleeding or obstructive mucous plugs, and a diagnosis of diffuse alveolar hemorrhage was made. The patient was gradually weaned off the ventilator and made a slow recovery over a one - week period.
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Affiliation(s)
- Ashish K Khanna
- Resident Anesthesiologist and Resident Research Coordinator, Anesthesiology Institute, Cleveland Clinic Foundation 9500 Euclid Avenue, Mailcode E-30,Cleveland, Ohio 44195, USA
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