OCR Text |
Show 116 LITERATURE ABSTRACTS from an unspecified larger population who received multiple infusion therapies. Although the text says that nine patients experienced pigmentary maculopathy secondary to the infusions, only eight patients on the summary table are graded as having had detectable maculopathy. Several patients had cranial radiation therapy, but in only one patient were fundus changes believed to be secondary to this. The one patient with vertebral injections only had no eye abnormalities, and in all patients with maculopathy, multiple carotid infusions had been given with or without vertebral infusions. Curiously, one patient with multiple right carotid injections had bilateral maculopathy, and in another the severity of maculopathy was worse in the carotid side with the fewer infusions of chemotherapy. No patient had substantial visual loss secondary to the maculopathy. This is not earth-shattering information, nor are the data presented as concisely and clearly as possible, but it is of interest to those who care for patients before and after treatment with infusion chemotherapy for cerebral neoplasms. Lyn A. Sedwick, M.D. Life-Threatening Complication of Retrobulbar Block. Brookshire GL, Gleitsmann KY, Schenk EC. Ophthalmology 1986;93:1476-8 (Nov). [Reprint requests to Dr. G. 1. Brookshire, Chief, Anesthesia and Operative Service, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905-5650.] Respiratory Arrest Following Retrobulbar Anesthesia. Wittpenn JR, Rapoza P, Sternberg Jr P, Kuwashima L, Saklad J, Patz A. Ophthalmology 1986;93:867-70 (July). [Reprint requests to Dr. J. R. Wittpenn, Wilmer Institute, B-23, Johns Hopkins Hospital, 601 N. Wolfe Street, Baltimore, MD 21205.] The first article is a case report of a patient who received a retrobulbar block of a 4-ml mixture of 3 ml 0.75% bupivacaine, 3 m12% lidocaine, and 1 ml hyaluronidase and 2 min later became unresponsive, apneic, and bradycardic, with mid-dilated pupil noted in the contralateral eye. After 10 min, the patient had bilateral unreactive pupils and eventually demonstrated near-total ophthalmoplegia, with absence of doll's head responses. The patient was intubated and recovered completely. 1Gin Neuro-ophtllQll1lo/, Vol. 7, No.2, 1987 The authors give various arguments against intraarterial injection, toxic drug reaction, or primary cardiovascular event and postulate that the retrobulbar injection may have entered the subarachnoid space resulting in brain stem anesthesia (multiple cranial neuropathies, loss of consciousness, and apnea). The second article was published during the review period of the first. Interestingly, the authors of that prospective study of 3,123 retrobulbar blocks, which resulted in respiratory arrest in nine patients do not agree with the subarachnoid route, do not come to a conclusion about the mechanism, but do find that 4% lidocaine is riskier than 2% lidocaine and that the amount of anesthetic injected increases risk of respiratory arrest. Lyn A. Sedwick, M.D. Prevention of Ocular Toxicity of Carmustine (BCNU) with Supraophthalmic Intracarotid Infusion. Chrousos GA, Oldfield EH, Doppman JL, Cogan DG. Ophthalmology 1986;93:1471-5 (Nov). [Reprint requests to Dr. G. A. Chrousos, Center for Sight, Georgetown University Department of Ophthalmology, Kober-Cogan Building, 5th Floor, 3800 Reservoir Road, Washington, DC 20007.] These authors examine patients treated via carotid catheter for cerebral malignancy with carmustine (BCNU), which had been found to cause ipsilateral severe visual loss secondary to retinitis in seven of 10 patients. In nine patients, treatment was attempted via a small catheter advanced beyond the ophthalmic artery-in only six patients was this position achieved for each treatment, and none of these patients had opthalmic complications. This paper is reviewed by Andrew Vine, who (1) notes that increased neurologic complications may result from such a technique, which has been discontinued by at least one center, and (2) points out several other variables that may affect the ophthalmic or neurologic toxicity of the agent (dose, solvent used, rate of infusion). Lyn A. Sedwick, M.D. Acute Obstruction of the Retinal and Choroidal Circulations. Brown GC, Magargal LE, Sergott R. |