[Post-operative cycloplegia following ophthalmic surgery: it is NOT anesthesia].

he practice of anesthesia has long been surrounded with a egree of mystique. This can be illustrated by the current ack of full-proof evidence on the mechanism of action of olatile anesthetics for example, which is for the most part ypothesized.1 These blurred margins of knowledge crossver into non-anesthesiologist practitioners using anesthetic echniques, sometimes, without fully grasping the full scope f knowledge associated to these (i.e. infiltration of local nesthetics, sedation). This mysticism of anesthesia is lso exemplified by anesthetics and anesthesiologist being rongfully accused for post-operative complications which annot be explained otherwise. A healthy 55-year-old female presented for anteriorhamber phakic intraocular-lens placement for correction f myopia of the left eye. The same procedure was perormed on the right eye using retrobulbar anesthesia a ew weeks prior uneventfully. Standard American Society of nesthesiologists (ASA) monitors were placed, the patient as pre-medicated with 2 mg of intravenous midazolam, fter which a retrobulbar block was performed. With the cular globe in primary position a 23 G 31 mm needle was nserted through the skin of the infero-temporal orbital rim. he needle was advanced 15 mm tangentially and subseuently re-directed upwards and inwards to reach proximity o the muscle cone. With prior negative aspiration, 3 ml of .75% bupivacaine were injected. After 5 minutes internal nd external ophthalmoplegia, as well as ocular anesthesia ere achieved and the surgery proceeded uneventfully. On post-operative day one the patient referred 7/10 pain on an 11-point visual analog scale, (VAS), anchored with = no pain and 10 = worst pain ever experienced) to the left ye, with associated fixed mydriasis, and extraocular eye ovements were preserved. The patient was evaluated by he ophthalmologist, and the findings were deemed as residal anesthetic block and analgesics were prescribed. The atient was re-evaluated 3 days later with persistent sympoms; increased intraocular pressure was noted and treated E