Topical anesthesia complications

Lidocaine gel 2% has been compared with 0.5% tetracaine drops for topical anesthesia in cataract surgery in 25 patients (331). There were no corneal epithehal or ocular surface complications, demonstrating the safety of the gel, which may provide a more practical and efficient method of anesthesia, because it needs to be applied only once as opposed to three applications of the drops. 

Maher P. Methemoglobinemia an unusual complication of topical anesthesia. Gastroenterol Nurs 1998 21(4) 173-5. 

Abrams SM, Degnan TJ, Vinciguerra V (1980) Marrow aplasia following topical application of chloramphenicol eye ointment. Arch Intern Med 140 576-577 Adriani J, Zepernick R (1964) Clinical effectiveness of drugs used for topical anesthesia. JAMA 118 711 Albert T, Lewis N, Warpeha R (1982) Late pulmonary complications with use of mafenide acetate. J Burn Care Rehabil 3... 

Cataract patients, in general, have relatively little immediate postoperative pain. This absence of pain is, at least in part, due to the long duration of action (up to 12 hours) of bupivacaine used in retrobulbar anesthesia. Some practitioners recommend the use of oral analgesics, such as acetaminophen or ibuprofen, as needed, if the patient experiences minor discomfort in the immediate postsur-gical period.Topical NSAIDs are also reported to decrease immediate postoperative pain. Significant or persistent postoperative pain is considered to be abnormal and may be a symptom of such complications as corneal abrasion, bullous keratopathy, high lOP, or endophthalmitis. 

Malignant hyperpyrexia is a life-threatening condition that involves sustained muscle contraction, muscle damage, and the production of vast quantities of metabolic heat, carbon dioxide, and potassium. Although it is a rare complication of general anesthesia, it remains a topic of considerable interest (74). 

The possibility of increased maternal mortality is a topic of debate. In 1979 there were 150 maternal deaths (0.27 per 1000 births) in Germany, of which 15-25% were apparently related to regional anesthesia, with such complications as hypotension, systemic toxicity, total spinal block, hematoma, catheter rupture, and uterine injury (SED-12, 253) (154). However, obstetric regional... 

Sensory systems Topical ocular anesthesia abuse is often misdiagnosed as acanthamoeba keratitis (a parasitic disease) and early identification to prevent ocular complications including superficial pxmctate keratitis, persistent epithelial defects, stromal/ring infiltrates, comeal oedema, endothelial damage and ocular inflammation is important. Local anesthetics may cause direct toxicity to the comeal epithelium, stroma and endothelium. Preservatives in the anesthetics may also contribute to toxicity. Patient demographics may include a health care association and/or psychiatric illness [25 ]. Evisceration of the eye after persistent topical anesthetic use has been described [26 ]. 

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