Reactions 1169 - 15 Sep 2007

SBupivacaine

CNS toxicity following inadvertent IV administrationtreated with soya oil emulsion: case report

An 18-year-old girl developed CNS toxicity following theinadvertent IV administration of bupivacaine and was treatedsuccessfully with soya oil emulsion.

The woman, who had presented for labour induction at38 weeks gestation, had borderline hypertension(180/81mm Hg), mild proteinuria and an unsatisfactorynonstress test. Epidural analgesia was requested after hermembranes were ruptured and she received a test dose oflidocaine, without IV or spinal effects. She then received 6mLof isobaric bupivacaine 0.25% over 2-3 minutes. Her BPincreased slowly over the next 15 minutes to 172/114mm Hg,with a HR of 86 beats/min. She received oxygen and, inanticipation of a caesarean section, fentanyl was administeredvia the epidural catheter. Her blood pressure increased furtherover the next 15 minutes to 165/123mm Hg, with a HR of119 beats/min. Following a negative aspiration check, shereceived 10mL of bupivacaine 0.5% via the catheter. Shebecame agitated and restless within 90 seconds and did notobey commands. She experienced twitching of her face andlimbs. Further catheter aspiration showed that venous bloodwas easily withdrawn. She became unresponsive; her BP wasmaintained at 150/110mm Hg and her HR was 120 beats/min.

The woman received two 50mL bolus doses of soya oilemulsion 20% and then 400mL as an infusion. She regainedconsciousness within 30 seconds; her BP and HR were170/109mm Hg and 88 beats/min, respectively. She thenunderwent emergency caesarean section under generalanaesthesia. Her postoperative course was uneventful; her BPsettled following magnesium sulfate and labetalol infusiontherapy. Both mother and baby were discharged onpostoperative day 4.

Author comment: "I believe that this patient’s epiduralcatheter migrated into an epidural vein, and that hersymptoms were due to inadvertent intravenous bupivacaine."Spence AG. Lipid reversal of central nervous system symptoms of bupivacainetoxicity. Anesthesiology 107: 516-517, No. 3, Sep 2007 - Bermuda 801091319

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Reactions 15 Sep 2007 No. 11690114-9954/10/1169-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved