Reactions 1061 - 23 Jul 2005

Bupivacaine

Laryngospasm: case reportA 42-year-old man developed laryngospasm during spinal

anaesthesia with bupivacaine.The man was scheduled to undergo elective debridement

and skin grafting of both feet following a road traffic accident.He received premedication 1 hour prior to anaesthetic, atwhich time he had been fasting for approximately 14 hours. Hereceived midazolam for anxiety prior to surgery, and a lumbarpuncture was performed. Approximately 8 minutes after theadministration of 2.5mL of hyperbaric 0.5% bupivacaine(12.5mg) into the subarachnoid space, he suddenly developedstridor and bradycardia. His oxygen saturation level haddecreased to as low as 60%, but there were artifacts caused byhis movement. He was awake and indicated that he wasunable to breathe.

Supplementary oxygen was administered and surgeonsprepared for endotracheal intubation. The man’s HR was48 beats/min and his BP was 70/30 mmHg. He was treatedwith IV atropine for bradycardia and IV fluids, followed by IVephedrine for hypotension. Within 10–15 seconds, thelaryngospasm reversed. His HR and BP increased to115 beats/min and 124/65mm Hg, respectively, and hisoxygen saturation was 100% while breathing. Intubation wasabandoned. Surgery was able to proceed, and the man did notexperience any further problems.

Author comment: "We propose that the laryngospasmwas secondary to increased vagal tone. . . Increased vagaltone was a result of the subarachnoid block in our patientwho probably had pre-existing intravascular volume deficit."Subramani K, et al. Laryngospasm during subarachnoid block. British Journal ofAnaesthesia 94: 668-670, No. 5, May 2005 - India 800994631

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Reactions 23 Jul 2005 No. 10610114-9954/10/1061-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved