Brainstem anaesthesia revisited: Mechanism, presentation and management

SummaryBrainstem anaesthesia is the temporary loss of functions of the brainstem. Although rare, it is a life threatening complication with varied presentations following traditional retrobulbar block. This complication had been reported and continues to be reported following other relatively safer orbital blocks. A systematic search of Medline, EMBASE, and Cochrane databases with the subject headings “brainstem”, “anaesthesia”, “regional anaesthesia”, “orbital block”, “eye blocks” and “local anaesthesia” was performed. There were several case reports of brainstem anaesthesia and none of the orbital regional blocks were considered absolutely safe. Most published cases reported in the previous decades were usually associated with retrobulbar block and these continued to be reported despite the recommendations. This review focuses on brainstem anaesthesia incidence, mechanism, diagnosis, immediate management and preventative measures.