Reactions 1373 - 15 Oct 2011

SBupivacaine

Pulmonary embolism: case reportA 48-year-old man developed pulmonary

thromboembolism after treatment with combined spinaland epidural analgesia with bupivacaine before surgery.

The man, who was a smoker, was scheduled for surgicalfixation of a right femoral fracture. An epidural catheter wasplaced at L3-L4, fixed at 11cm [drugs not stated]. At thesame level, a spinal needle was used to administer 15mg of0.5% bupivacaine heavy to the subarachnoid space. About35 minutes later, during surgery, he developed dyspnoeaand chest pain. His oxygen saturation fell, and he becametachypnoeic with coughing. A mask was used to deliveroxygen, but he had further coughing; pulmonary embolismwas suspected. Dopamine was initiated; reduced breathsounds on his right side were noted.

The man was anaesthetised and intubated. Chest x-rayrevealed right-sided pneumothorax, and an intercostaldrain was placed. The surgery was completed, and he wasmoved to an ICU with mechanical ventilation. D-dimer wasfound to be elevated, and Doppler scan revealed deep veinthrombosis of his right leg. He received enoxaparin andepidural bupivacaine. He was extubated after 3 days, anddischarged home on day 15.

Author comment: "Chronic smokers are at a higher risk ofdeveloping deep vein thrombosis, which can lead to[pulmonary thromboembolism] following venodilation due tospinal anesthesia."Bansal S, et al. Pneumothorax complicating pulmonary embolism after combinedspinal epidural anesthesia in a chronic smoker with open femur fracture. Journal ofAnaesthesiology Clinical Pharmacology 27: 403-405, No. 3, Jul-Sep 2011.Available from: URL: http://dx.doi.org/10.4103/0970-9185.83695 -India 803061306

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Reactions 15 Oct 2011 No. 13730114-9954/10/1373-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved