Reactions 1126 - 4 Nov 2006

SBupivacaine

Respiratory failure following epidural administrationin a patient with uncontrolled hyperthyroidism: casereport

A 47-year-old woman with uncontrolled hyperthyroidismdeveloped respiratory failure during epidural anaesthesia withbupivacaine prior to emergency lower-abdominal laparotomy.

After insertion of an epidural catheter at theL3-4 intervertebral space, 2mL of 0.5% bupivacaine wasadministered through it to exclude subarachnoid placement.Following incremental administration of 0.5% bupivacaine14mL, the woman developed difficulty breathing and oxygendesaturation.

The woman’s lungs were ventilated with 100% oxygen.Sensory block was at the T5 level. Surgery continued undermask ventilation, with the following arterial blood gas values:pH 7.27, partial pressure of oxygen 170.5mm Hg, partialpressure of carbon dioxide 60.2mm Hg, base deficit 1 mmol/Land bicarbonate 26.9 mmol/L. Following manual ventilationfor 30 minutes, she developed synchronised thoraco-abdominal movements with an increased tidal volume. Maskventilation was no longer needed after 45 minutes. Her arterialblood gas values were normal postoperatively.

Author comment: On a "background of prolonged,uncontrolled hyperthyroidism, neuraxial block with localanesthetics can unmask the weakness of the respiratorymuscles and result in a life-threatening situation such asrespiratory failure".Biswas BK, et al. Respiratory failure after lumbar epidural anesthesia in a patientwith uncontrolled hyperthyroidism. Anesthesia and Analgesia 103: 1061-1062, No.4, 1 Oct 2006 - Nepal 801045276

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Reactions 4 Nov 2006 No. 11260114-9954/10/1126-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved