Anestesia retrobulbar com catéter flexível de Teflon em pacientes com comprimento axial ocular aumentado

Dantas, Paulo E. C.; Nishiwaki-Dantas, M. Cristina; Henriques, Marta Junqueira; Almeida, Geraldo V. de

doi:10.5935/0004-2749.19980109

RESUMO

Dentre as complicações associadas à anestesia retrobulbar e peribulbar, perfuração do globo ocular parece ser das mais importantes. Recente estudo ultrassonográfico demonstrou que, em pacientes submetidos à anestesia retrobulbar para cirurgia de catarata com comprimento axial normal, a ponta da agulha usada para injeção retrobulbar se encontrava muito próxima do globo ocular, as vezes até indentando sua parede. Tal fato pode se tornar extremamente perigoso em olhos com comprimento axial aumentado, como nos altos míopes.

Demonstramos a eficácia e segurança do uso da técnica de anestesia retrobulbar com catéter flexível de Teflon em 15 pacientes com comprimento axial ocular ântero-posterior aumentado e candidatos à facectomia.

Palavras-chave:
Anestesia local (regional); Retrobulbar; Peribulbar; Subtenoniana; Complicações

SUMMARY

Globe perforation is one of the most serious complications associated with retrobulbar or peribulbar anesthesia, with high impact on future vision. Ultrassonography of retrobulbar space in patients submitted to retrobulbar anesthesia with normal ocular axial length has shown that retrobulbar needle tips are closer to the globe than previously thought. This could be dangerous in patients with enlarged eye such as in high myopia.

We describe the use of retrobulbar anesthesia with a flexible catheter in 15 patients with extended axial ocular length.

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REFERÊNCIAS BIBLIOGRÁFICAS

¹
Knapp H. On cocaine and its use in Ophthalmology and general surgery. Arch Ophthalmol 1884;13:402-8.
²
Schneider ME, Milstein DE, Oyakawa RT et al. Ocular perforation from a retrobulbar injection. Am J Ophthalmol 1988; 106:35-40.
³
Kimble JA, Morris RE, Whiterspoon CD, Feist RM. Globe perforation from peribulbar anestesia. Arch Ophthalmol 1987;105:749.
⁴
Hay A, Flynn HW, Hoffman JI, Rivera DH. Needle penetration of the globe during retrobulbar and peribulbar injection. Ophthalmology 1991;98:1017-24.
⁵
Rinkoff JS, Doft BH, Lobes LA. Management of ocular penetration of local anesthesia preceding cataract surgery. Arch Ophthalmol 1991;109:1421-5.
⁶
Feibel RM. Current concepts in retrobulbar anesthesia. Surv Ophthalmol 1985;30:102-10.
⁷
Sullivan KL, Brown GC, Forman AR et al. Retrobulbar anesthesia and retinal vascular obstruction. Ophthalmology 1978;90:373-7.
⁸
Goldchmit M, Scott AB. Avaliação da motilidade extrínseca ocular de pacientes facectomizados sob anestesia retrobulbar. Arq Bras Oftal 1994;57:114-6.
⁹
Peterson WC, Yanoff M. Subconjunctival anesthesia. An alternative to retrobulbar and peribulbar techniques. Ophthalmic Surg 1991;22:199-201.
¹⁰
Furuta M, Toriumi T, Kashiwagi K et al. Limbal anesthesia for cataract surgery. Ophthalmic Surg 1990;21:22-5.
¹¹
Aquavella J. Comment (Limbal anesthesia for cataract surgery.). Ophthalmic Surg 1990;21:26.
¹²
Birch AA, Evans M, Redembo E. The ultrassonic location of retrobulbar needle during retrobulbar block. Ophthalmology 1995;102:824-6.
¹³
Dantas PECD, Nishiwaki-Dantas MC, Henriques MJ, Almeida GV. Retrobulbar anesthesia with a flexible catheter. Ophthalmic Surg Laser 1996;27:275-8.
¹⁴
Tamai M. A retained retrobulbar catheter for repetitive injection of anesthetics during ophthalmic surgery. Ophthalmic Surg 1983;14:579-81.
¹⁵
Greenbaum S. Parabulbar anesthesia. Am J Ophthalmol 1992;114:776.

Datas de Publicação

Publicação nesta coleção
Feb 1998

Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que o trabalho original seja corretamente citado.

[1] ¹
Knapp H. On cocaine and its use in Ophthalmology and general surgery. Arch Ophthalmol 1884;13:402-8.

[2] ²
Schneider ME, Milstein DE, Oyakawa RT et al. Ocular perforation from a retrobulbar injection. Am J Ophthalmol 1988; 106:35-40.

[3] ³
Kimble JA, Morris RE, Whiterspoon CD, Feist RM. Globe perforation from peribulbar anestesia. Arch Ophthalmol 1987;105:749.

[4] ⁴
Hay A, Flynn HW, Hoffman JI, Rivera DH. Needle penetration of the globe during retrobulbar and peribulbar injection. Ophthalmology 1991;98:1017-24.

[5] ⁵
Rinkoff JS, Doft BH, Lobes LA. Management of ocular penetration of local anesthesia preceding cataract surgery. Arch Ophthalmol 1991;109:1421-5.

[6] ⁶
Feibel RM. Current concepts in retrobulbar anesthesia. Surv Ophthalmol 1985;30:102-10.

[7] ⁷
Sullivan KL, Brown GC, Forman AR et al. Retrobulbar anesthesia and retinal vascular obstruction. Ophthalmology 1978;90:373-7.

[8] ⁸
Goldchmit M, Scott AB. Avaliação da motilidade extrínseca ocular de pacientes facectomizados sob anestesia retrobulbar. Arq Bras Oftal 1994;57:114-6.

[9] ⁹
Peterson WC, Yanoff M. Subconjunctival anesthesia. An alternative to retrobulbar and peribulbar techniques. Ophthalmic Surg 1991;22:199-201.

[10] ¹⁰
Furuta M, Toriumi T, Kashiwagi K et al. Limbal anesthesia for cataract surgery. Ophthalmic Surg 1990;21:22-5.

[11] ¹¹
Aquavella J. Comment (Limbal anesthesia for cataract surgery.). Ophthalmic Surg 1990;21:26.

[12] ¹²
Birch AA, Evans M, Redembo E. The ultrassonic location of retrobulbar needle during retrobulbar block. Ophthalmology 1995;102:824-6.

[13] ¹³
Dantas PECD, Nishiwaki-Dantas MC, Henriques MJ, Almeida GV. Retrobulbar anesthesia with a flexible catheter. Ophthalmic Surg Laser 1996;27:275-8.

[14] ¹⁴
Tamai M. A retained retrobulbar catheter for repetitive injection of anesthetics during ophthalmic surgery. Ophthalmic Surg 1983;14:579-81.

[15] ¹⁵
Greenbaum S. Parabulbar anesthesia. Am J Ophthalmol 1992;114:776.

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