Drs Kushner and Olson presented four cases of retinal hemorrhage following epidural steroid injections performed in our institution. A letter to the editor from Drs Poulton and Pero has been presented to us and a response has been requested.
We wish to point out several errors or misconceptions that appear in one or both manuscripts. We do not believe that incremental doses of thiopental sodium, used to enhance patient comfort in a variety of regional blocks, including epidural steroid injections, should be characterized as general anesthesia. It is not uncommon for our patients to be awake as the injection is completed.
Although Dr Kushner's report did describe the patient position as head down, we are assured that none of the nine anesthesiologists in our practice places patients with the head down. The stretcher remains horizontal. In fact, amazingly, some patients request pillows under their heads even in the prone position.
Williams RC, Doliner SJ, Lipton RM, Franz JA, Delaney RD. Retinal Hemorrhage as a Consequence of Epidural Steroid Injection. Arch Ophthalmol. 1996;114(3):362-363. doi:10.1001/archopht.1996.01100130357038