球后麻醉的并发症

Pooley于1914年首先报告用普鲁卡因作球后麻醉。它是眼科手术常用的麻醉方法,虽较安全、有效,但也有各种并发症。它包括:暂时性黑蒙、暂时性黑蒙伴有其它颅神经症状、视网膜血管阻塞或痉挛、眶内出血、眼球穿孔、呼吸循环障碍和脑干麻痹。简述如下:     

眼球筋膜下麻醉在眼科手术中的应用

目的探讨眼球筋膜下麻醉在眼科手术中的应用效果、优点及作用机制。方法由鼻上方近角膜缘球结膜下小切口伸入钝性针头并注射2％利多卡因和0．75％布比仁因1：1混合液2mL，使局部球筋膜下充满药液，开展各种手术操作219眼。结果219眼麻醉效果满意，手术顺利完成，无麻醉并发症发生。结论球筋膜下麻醉避免了对视神经、动、静脉血管，眼肌及眼球壁的机械性损伤，是一种安全，有效、并发症少的麻醉办法。     

眼科手术的局部麻醉球周技术

眼科手术的局部麻醉球周技术Ｒ．Ａ．ＦＲＹＡＮＤＪＨＥＮＤＥＲＳＯＮ山西省眼科医院赵军梅译王尔光校医生在眼科手术的局部麻醉中常显得力不从心，这是因为球后麻醉常常出现较严重的并发症尤其是球后出血，视神经损伤，眼球穿通伤，视网膜中央动脉阻塞和视神经鞘内注射...     

复方盐酸布比卡因注射液作为眼科手术麻醉用药的随机、双盲、多中心临床研究

背景 复方盐酸布比卡因注射液是国外眼科手术中局部麻醉的首选药物,而中国眼科临床手术中采用盐酸利多卡因和盐酸布比卡因单方混合注射液作为麻醉药物,虽然麻醉效果可靠,但需临床配制.复方盐酸布比卡因注射液已于2005年获得国家食品药品监督管理局批准生产,但其临床效果及安全性仍需要临床研究证实. 目的 评估国产复方盐酸布比卡因注射液用于眼科手术局部麻醉的临床效果和安全性.方法 采用多中心、随机、双盲临床试验设计.对河南省眼科研究所、青岛眼科医院、青岛市立医院、温州医学院附属眼视光医院、复旦大学附属眼耳鼻喉科医院符合纳入标准的223例眼科手术患者进行多中心、随机、双盲、阳性药物平行对照的临床试验,均纳入患者一侧眼.试验组患者行眼科手术前局部注射复方盐酸布比卡因注射液,对照组患者注射质量分数2％盐酸利多卡因及质量分数0.75％盐酸布比卡因两种单方等体积混合注射液.采取球后阻滞或球周麻醉法,每次用药量为3 ～ 10 ml.研究中主要评价药物的疗效指标和安全性评价指标,其中主要疗效指标为遵照Brahma 1994年建立的标准对注射麻醉药物后2、4、6、8、10 min以及手术结束时术眼和患者眼球和眼睑活动度进行评分,确定适宜的开始手术时间;次要疗效指标为眼科手术期间受试者疼痛评分.安全性评价指标包括药物局部注射后患者的眼部和全身不良事件发生情况以及患者的生命体征、血氧饱和度(SPO2)及心电图变化情况.采用Wilcoxon秩和检验法分别对意向性分析(ITT)和符合方案分析(PP)时试验组与对照组间各评价指标的差异进行比较.结果 ITT分析试验组入组118例,但由于药物注射后无法手术退出1例;对照组纳入120例;PP分析中试验组9例不符合试验设计,共纳入109例,对照组6例不符合试验设计要求,入组114例.无论是ITT分析还是PP分析,局部注射麻醉药物后2、4、6、8、10 min及手术结束时,试验组与对照组术眼眼球活动度评分及总评分的差异均无统计学意义(P＞0.05);两组间术眼用药后眼睑活动度评分及总评分差异均无统计学意义(P＞0.05).ITT分析和PP分析时两组间药物局部注射后各时间点术眼疼痛评分的差异均无统计学意义(P＞0.05),适宜开始手术时间的差异无统计学意义(P＞0.05).药物应用后共记录局部及全身不良事件5例,其中试验组4例,对照组1例,但两组间差异无统计学意义(P＞0.05).药物注射后患者生命体征各指标变化的例数、SPO2改变例数及心电图变化例数的差异均无统计学意义(P＞0.05).结论 复方盐酸布比卡因注射液用于眼科手术局部麻醉效果与盐酸利多卡因和盐酸布比卡因单方混合注射液相同,药物安全性好,适用人群广,经济性好,使用方法简便.     

爱尔卡因表面麻醉超声乳化人工晶状体植入术

传统的白内障手术多采用球后注射、球旁注射麻醉方法，由于其可致眶内出血、眼球穿孔、视神经损伤、上睑下垂等严重并发症，促使眼科医师寻求更安全、更有效的麻醉方法．超声乳化术具有切口小、损伤小、手术时间短等优点，使在表面麻醉下施行白内障手术成为可能［１］。我院自１９９９年元月至２０００年１２月共在０．５％爱尔卡因表面麻醉下行白内障超声乳化及人工晶状体植入术２８４眼，取得了满意的效果，现报告如下： 临床资料与方法 １． 一般资料 ２８４眼表面麻醉手术中，男１３９眼，女１４５眼，年龄１５岁至９６岁，平均年龄７３…     

眼科局部麻醉的应用进展

眼球的充分麻醉，对保证眼科手术的顺利进行，是至关重要的。而眼科局部麻醉与全麻比较，其术中、术后减少了许多并发症的发生，如术后意识模糊、体位性低血压、呕吐等，且允许术后尽早的活动，因此局麻在眼科手术中占据着相当重要的地位。临床上，除对那些估计手术创伤大，病人无法耐受的手术，或病人因精神因素不能合作等必须施行全麻手术以外，绝大多数眼科手术都首选局部麻醉。许多年来，人们在对传统的球后麻醉方法进行改进的同时，对球周麻醉、球结膜下麻醉等其它形式的麻醉方法也进行了尝试。实践证明，它们可达到类似球后麻醉的临床…     

眼球筋膜囊下麻醉联合表面麻醉在眼科手术中的应用

目的:评价眼球筋膜囊下麻醉联合表面麻醉行各种常见眼科显微手术的安全性和有效性。方法:对246例246眼使用眼球筋膜囊下麻醉联合表面麻醉后,进行各种眼科手术,观察麻醉效果及其并发症。结果:麻醉效果:Ⅰ级221眼占89.84%,Ⅱ级20眼占8.13%,Ⅲ级5眼占2.03%,无1例发生麻醉并发症。结论:眼球筋膜囊下麻醉联合表面麻醉行眼科显微手术安全性高,麻醉效果好,麻醉并发症少,是一种值得推广的麻醉方法。     

白内障手术中应用单点注射小剂量球周麻醉的效果

白内障手术中应用单点注射小剂量球周麻醉的效果［英］／ＡｇｒａｗａｌＶ…Ｊ　ＣａｔａｒａｃｔＲｅｆｒａｃｔＳｕｒｇ．－１９９４，２０（１）．－６１～６３目前临床上白内障手术所采用的球后麻醉可产生一些严重的并发症，例如：脑干麻醉、视神经损伤、眼球穿孔、视...     

球后麻醉的现代概念

一百多年来,眼科手术是在局部麻醉下进行。实际上,局部麻醉是眼科医师发现的。球后注射可将各种药物——麻醉剂、抗生素、激素、血管扩张剂、酒精和其他药物,注入到眼球后和周围组织内。本文综述1974年以来球后麻醉的新技术和药物。一、新药物(一)Etidocaine(依替卡因) 依替卡因是酰胺类局部麻醉剂,结构与lidocaine(利多卡因)和bupivacaine(丁哌卡因)     

球周麻醉在眼科手术中的应用

在球周麻醉下成功施行眼科手术33例,其中老年性白内障23例,青光眼4例,裂源性网脱6例。用计分法主观评价三种手术球周麻醉的效果,结果表明以白内障囊外摘除术(显微)的麻醉效果最为满意。球周麻醉具有球后麻醉和眼轮匝肌麻醉的双重效果,它不但可以替代球后麻醉,还可免除面神经阻滞麻醉。由于麻药仅注射在眼球周围,不达球后,故能避免球后麻醉所引起的球后出血及突发性黑蒙等严重并发症。     

改良羟基磷灰石义眼台一期植入的观察

目的评价改良义眼台一期植入术的临床的效果。方法62例（62眼）因各种原因行眼内容摘除后，在局麻或全麻下，采用义眼台药物浸泡，不剪断视神经，保留角膜的改良方法，进行I期植入。结果57例结果良好。发生并发症5例，其中义眼台暴露3例，肉芽肿1例，感染1例。结论改良的义眼台I期植入术，纤维血管内生长快，并发症少，眼窝饱满，眼球活动度好，无1例发生交感染性眼炎。     

Orbital regional anesthesia: complications and their prevention

Serious complications following orbital regional anesthesia are rare, but occur following both needle and blunt cannula (sub-Tenon's) techniques. Each technique of orbital regional anesthesia has its own risk/benefit profile. This article reviews the etiology, risk factors, treatment and prevention of complications of commonly used akinetic orbital blocks. Ophthalmologists and ophthalmic anesthesiologists must be prepared to deal with rare, but serious complications, that can occur with any technique of orbital regional anesthesia.     

Evaluation of single-injection caruncular sub-Tenon's anesthesia

INTRODUCTION: Because of its complications, particularly globe perforation, retrobulbar injection has been progressively replaced by peribulbar anesthesia. However, with peribulbar anesthesia, the excessive rate of imperfect blockade requires supplemental injection. We have been performing local anesthesia using caruncular sub-Tenon single injection for many years. This technique is evaluated. PATIENTS AND METHODS: A prospective study has been carried out on 183 eyes. Regional anesthesia was given by a caruncular sub-Tenon single injection. For each case, we studied akinesia, analgesia, pain before, during, and after surgery, the number of supplemental injections, eyeball orientation, and surgical conditions. RESULTS: A total motor blockade was obtained in 157 cases (85.8%) and total lid akinesia in 176 patients (96.2%). Eight patients (4.4%) needed a second injection. During surgery, 10 patients complained of pain (5.5%). We found 27 eyes (14.7%) were divergent and 12 (6.5%) were convergent. Surgical conditions were good or very good in 90% of cases. No complications due to the injection (perforation or lesion of the eyeball or the optic nerve) were noted. CONCLUSION: Single-injection caruncular sub-Tenon anesthesia is an alternative technique to classical peribulbar anesthesia. This technique is efficient, simple, easy to learn, reproducible, and seems to have a low rate of complications.     

表面麻醉用于人工晶状体植入联合小梁切除术

目的 评价表面麻醉在白内障超声乳化及人工晶状体植入联合小梁切除术中的麻醉效果。方法 采用表面麻醉的方法超声乳化白内障摘除联合小梁切除术26例（26眼）。记录患者在接受表麻、作巩膜隧道、超声乳化术中、虹膜周切、术后这5个阶段的患者感觉,同时记录术中是否有眼睑挤压、眼球转动及其配合程度。结果 26例患者中麻醉时无痛和轻微疼痛者为26例（100％）;中等程度疼痛者于超声乳化术中占1例,虹膜周切时占2例,术后占1例,且都能忍受;重度疼痛者无,88．5％患者能很好地配合手术,术中无麻醉引起的并发症发生。结论 该麻醉方法适用于白内障超声乳化及人工晶状体植入联合小梁切除术,不仅避免了球后或球周麻醉的诸多并发症而且使手术变得更加简单、安全。     

Brainstem anesthesia presenting as dysarthria.

After having a retrobulbar injection for anesthesia before cataract surgery, a patient developed dysarthria. This was the presenting sign for penetration of the optic nerve sheath by the retrobulbar injection, with subsequent brainstem anesthesia. Thereafter, the patient demonstrated cranial nerve dysfunctions with tongue deviation, tachycardia, hypertension, and contralateral sixth and third nerve palsies. I believe this is the first documented case in which dysarthria is the presenting sign for brainstem anesthesia resulting from a retrobulbar injection.     

Impairment of ocular blood flow during regional orbital anesthesia

BACKGROUND: Regional anesthesia for ophthalmic surgery has been associated with ischemic complications, such as central retinal vascular occlusion, optic atrophy and ischemic optic neuropathy. Impairment of pulsatile ocular blood flow (POBF) may occur with regional orbital anesthesia. In this study we quantified POBF in patients undergoing regional orbital anesthesia. METHODS: Eleven patients (12 eyes) with a mean age of 76.5 years having regional orbital anesthesia for cataract or retinal surgery at a private refractive surgical centre in Calgary had POBF monitoring before, during and 15 minutes after induction of anesthesia. RESULTS: There were no significant changes in intraocular pressure or heart rate during the induction phase or 15 minutes after induction of regional orbital anesthesia. However, ocular blood flow indices, including pulse amplitude, pulse volume and POBF, were significantly reduced following attainment of regional orbital blockade (p < 0.05). With time there was recovery in these variables, but they all remained significantly reduced from baseline 15 minutes later. INTERPRETATION: Ocular blood flow appears to be significantly impaired during regional orbital anesthesia, induced as described. There could be benefit in monitoring POBF to reveal otherwise undetectable deleterious effects on retinal circulation in patients having retrobulbar injections, orbital compression or digital manipulation of the globe.     

Local anesthesia in ophthalmic surgery

In recent years anesthesia modalities have changed in ophthalmic surgery. A growing trend toward the use of topical anesthesia in cataract surgery is apparent. The present-day techniques used in ophthalmic surgery are retrobulbar anesthesia, peribulbar anesthesia, subtenon anesthesia, and subconjunctival anesthesia as injection techniques, topical anesthesia using drops, gel, or sponge, and intracameral anesthesia. Injectable anesthesia (RBA, PBA, STA) provides a higher level of analgesia and globe akinesia. With injection techniques the risks of vis a tergo and anesthetic complications increase; the level of analgesia after topical anesthesia could be improved by supplementation with i.v. narcotics.     

Lokalanästhesie in der Ophthalmochirurgie

In recent years anesthesia modalities have changed in ophthalmic surgery. A growing trend toward the use of topical anesthesia in cataract surgery is apparent. The present-day techniques used in ophthalmic surgery are retrobulbar anesthesia, peribulbar anesthesia, subtenon anesthesia, and subconjunctival anesthesia as injection techniques, topical anesthesia using drops, gel, or sponge, and intracameral anesthesia. Injectable anesthesia (RBA, PBA, STA) provides a higher level of analgesia and globe akinesia. With injection techniques the risks of vis a tergo and anesthetic complications increase; the level of analgesia after topical anesthesia could be improved by supplementation with i.v. narcotics.     

兔眼眶动脉血管铸型和灌注解剖

目的观察兔眼球和眼眶的血液供应。方法血管铸型和灌注解剖。结果观察43个标本。眼外动脉的分支睫状动脉供给眼球、眶内视神经、眼外肌和软组织大部分血液。眼内动脉较眼外动脉细得多，79．l％在不同部位加入睫状动脉，仅20，9％直接走向眼球作为视网膜动脉。结论眼外动脉是眶内的主要供血动脉，眼内动脉起辅助作用。来自眼外动脉的睫状动脉是眶内最重要的动脉。