Peribulbar anaesthesia in ophthalmic surgery linked to development of pulmonary oedema

Researchers have found in  new study that Peribulbar anaesthesia in ophthalmic surgery was linked to development of  pulmonary oedema. Further it was found that majority of patients developed Pulmonary oedema during vitreoretinal procedures, particularly diabetic vitrectomies.

The research has been published in the Indian Journal of Anaesthesia. 

Recently published research investigates the occurrence of pulmonary edema (PE) in patients undergoing ophthalmic surgeries under regional anaesthesia.

The study is a retrospective observational analysis of patients who developed Pulmonary oedema during ophthalmic surgical procedures scheduled between 2019 and 2021. A total of 56,334 surgeries performed under regional anaesthesia were studied, and 27 patients (0.047%) developed Pulmonary oedema. The mean age of occurrence was 55.8 years, with hypertension and diabetes being the most common comorbidities among the affected patients. The majority of patients developed Pulmonary oedema during vitreoretinal procedures, particularly diabetic vitrectomies. Symptoms included breathing discomfort, tachypnoea, tachycardia, elevated blood pressure, and decreased oxygen saturation levels. The authors note that the incidence of Pulmonary oedema in this study was higher than the previously reported 0.006% incidence of major systemic complications in patients receiving peri-bulbar block. They also discuss the association between PE occurrence and the use of phenyl epinephrine eye drops, as well as the impact of underlying systemic comorbidities on lowering the threshold for Pulmonary oedema development. The paper suggests that slow diffusion of local anaesthetics into the medulla and suboptimal ventricular function due to systemic comorbid conditions may contribute to the development of Pulmonary oedema in these patients. The study provides valuable insights into the incidence and associated factors of Pulmonary oedema in ophthalmic surgeries under regional anaesthesia, highlighting the need for further research to understand and prevent such complications in this patient population.

Reference -

Kasanavesi, Ramakrishna Chaitanya; Dave, Vivek Pravin1; Jalali, Subhadra1; Rao, Rajanarsing. Pulmonary oedema in ophthalmic surgeries under peribulbar anaesthesia: A retrospective analysis. Indian Journal of Anaesthesia 67(11):p 1009-1010, November 2023. | DOI: 10.4103/ija.ija_623_23