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B62 Peribulbar and sub-tenon’s blockades: effective anesthetic techniques for eye surgery in a patient with infective endocarditis – a case report
  1. C Pinto,
  2. MJ Quelhas,
  3. MM Armindo and
  4. L Cruz
  1. Unidade Local de Saúde de Matosinhos – Hospital Pedro Hispano, Matosinhos, Portugal


Background and Aims Infective endocarditis (IE) is a microbial infection of heart valves or mural endocardium, but mainly a multisystemic disorder.1Endogenous endophthalmitis is one of its complications. The literature is sparse about these two conjoint entities and anesthesia approach for patients with IE proposed for noncardiac surgery. We present a locorregional alternative to general anesthesia.

Methods A 64-year-old-woman, ASA IV, diagnosed with an endogenous IE byEnterococcus faecalisand concomitant endophthalmitis was proposed to vitrectomy.

The patient had two mechanical heart valves (aortic and mitral) since 2007 due to rheumatic disease and atrial fibrillation anticoagulated with warfarin.

With evidence of vegetations in mitral and tricuspid valves, six weeks of treatment with vancomycin and gentamicin were indicated.

After multidisciplinary discussion, benefits of ophthalmologic surgery seemed to outweigh the risks of delaying the procedure for six weeks for antibiotic treatment completion.

Results For vitrectomy, peribulbar and sub-Tenon’s blockades were performed using 3 and 4 mL of ropivacaine 1%, respectively, with further application of Honan balloon, under mild sedation with intravenous midazolam (total of 3mg) and alfentanil (total of 400mcg).

During the procedure (duration 100 minutes), hemodynamic stability and good surgical conditions were maintained.

The perioperative period was uneventful.

Conclusions IE is a systemic life-threatening disease, being prosthetic heart valves one of the major risk factors.1

Endogenous endophthalmitis is generally associated with high mortality and poor visual outcomes.2

Eye peripheral blockades decrease anesthetic risk.

Plus, avoiding general anesthesia and orotracheal intubation, the risk of endocarditis implantation in other prosthetic valves was reduced3and hemodynamic stability was maintained.

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