Reactions 1250 - 2 May 2009

SBupivacaine

Various toxicities following displacement ofepidural catheter during surgery: case report

A 60-year-old woman developed systemic toxicity afteran epidural catheter containing bupivacaine was displacedduring colporrhaphy surgery.

Prior to surgery, an epidural catheter was inserted at theL4-L5 level, and 0.5% bupivacaine 15mL was injectedslowly for local anaesthesia. The woman was then placed inthe lithotomy position and surgery began. Twenty minuteslater, her pulse dropped to 50bpm. She was administeredatropine and the bradycardia resolved. At the end of the1.5 hour operation, she became disoriented and could notanswer any questions. Half an hour later, her level ofconsciousness was severely decreased, her respiration wasshallow and there was no reaction to pain stimuli.

The woman was intubated and administered thiopentalsodium and suxamethonium chloride [succinylcholinechloride]. At that time, she had severe respiratory acidosis.One hour after intubation, her BP dropped to 80/50mm Hgand did not rise despite treatment with Ringer’s lactate.After dopamine was given, her BP stabilised at100/65mm Hg. She was transferred to the ICU, where shereceived mechanical ventilation. On arrival, she sufferedgeneralised seizures, treated with diazepam and phenytoin.Thorough neurological investigation was normal. Shegradually recovered with no residual complications. Shewas extubated after 3 days, and after 5 days her CT and EEGwere normal. She was discharged in a stable condition7 days after surgery.

Author comment: "We believe that the epidural catheterwas dislocated while placing this patient in the lithotomyposition, consequently the epidural vessels were injured andsystemic uptake of local anesthetic took place which causedsystemic toxicity manifestations."Ghafari MH, et al. Systemic toxicity reactions due to epidural catheterdisplacement. Acta Medica Iranica 46: 518-520, No. 6, 2008 - Iran 801141058

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Reactions 2 May 2009 No. 12500114-9954/10/1250-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved