Brainstem anesthesia after peribulbar anesthesia

We report a case of pupilloplasty under peribulbar anaesthesia complicated by a brainstem anaesthesia requiring tracheal intubation and mechanical ventilation. Immediate outcome was good. We discuss the different mechanisms of this complication. The subarachnoidal (intrathecal) injection of local anaesthesic seems to be the most probable cause. The use of short needles should theoretically decrease the risk. Despite all these precautions, peribulbar anaesthesia should not be considered as an ordinary procedure.