Trifascicular block with syncope triggered by preoperative mydriatic eye drops for cataract surgery

Elsevier

Available online 20 September 2022

Journal Français d'OphtalmologieSummary

We report the case of an 85-year-old patient who developed trifascicular block with syncope, triggered by preoperative eye drops for cataract surgery. This life-threatening situation reopens the debate over the necessity of having an anesthesiologist present during cataract surgery.

Résumé

Nous présentons le cas d’un patient de 85 ans, ayant présenté un bloc trifasciculaire avec syncopes déclenché par les collyres préopératoires avant une chirurgie de la cataracte. Cette situation à risque vital pour le patient relance le débat sur la nécessité d’avoir un anesthésiste disponible pour une chirurgie de cataracte.

Introduction

We report the case of an 85-year-old patient, hospitalized as an outpatient for cataract surgery, who presented severe malaise with loss of consciousness before surgery.

Section snippetsCase's presentation

His medical history was limited to an obstructive sleep apnea and an essential tremor under propranolol. No surgical history, no toxic consumption. Preanesthetic consult reported a normal clinical examination, and uncomplete right bundle branch block.

As the usual procedure, prior to the surgery, the patient was treated with instillation of 10% phenylephrine and tropicamide (Mydriasert®).

An hour later, he presented two short-lived fainting spells with loss of consciousness in the outpatient

Discussion

This life-threatening episode was therefore attributed to the instillation of anticholinergic eye drops in a context of unrecognized dyskalemia.

This case illustrates the possible effects of drugs instilled in ophthalmology, including topical drugs.

This patient is classified ASA II (a patient with mild systemic disease). In this case, there were no justification to delay cataract surgery [1]. This case shows that the ASA Physical Status Classification System alone does not predict the

Conclusion

Our case therefore represents a rare but possible case. It reopens the debate on the performance of intraocular surgical procedures without anesthesiologist. For cataract surgery, mainly due to the physical status of patients but also because of the risk of unexpected adverse events the presence of an anesthesiologist in the OR should be mandatory.

Disclosure of interest

The authors declare that they have no competing interest.

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