Reactions 1281 - 5 Dec 2009

SBupivacaine

Chemical meningitis and allergic rhinitis: 4 casereports

Four women, aged 24-42 years, received spinalanaesthesia with bupivacaine [dosages not stated] within a3-day period at the same institute. All four women receivedthe a "chemically-related" anaesthetic to bupivacaine, lot001, produced by a Brazilian laboratory. Within 1-13 hoursof receiving bupivacaine, all four women developedchemical meningitis. Treatment with dexamethasone andceftriaxone was started. CSF analysis for one patientsuggested bacterial meningitis, and she also receivedvancomycin. Blood and CSF cultures showed no signs ofbacterial growth; eosinophils were present in three out offour CSF samples. After 10 days of treatment, CSF sampleswere normal. All four women were found to have allergicrhinitis, and were discharged without sequelae.

Author comment: "[W]e regard the chemical etiology ofthe aforementioned cases to be irrefutable, given that therewas no sign of bacterial growth in any of the cerebrospinalfluid samples and, principally, because of . . . the presence ofeosinophils in the cerebrospinal fluid, indicating a possiblecomponent of hypersensitivity."Dos Santos MC, et al. Outbreak of chemical meningitis following spinal anesthesiacaused by chemically related bupivacaine. Infection Control and HospitalEpidemiology 30: 922-924, No. 9, Sep 2009 - Brazil 801154843

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Reactions 5 Dec 2009 No. 12810114-9954/10/1281-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved