Reactions 1418 - 8 Sep 2012

Bupivacaine

Harlequin syndrome in an elderly patientfollowing extrapleural infusion: case report

A 76-year-old man developed Harlequin syndromeduring extrapleural infusion of bupivacaine for anaesthesiapost-thoracotomy.

The man, who had presented for resection of a rightupper lobe adenocarcinoma, received inductionanaesthesia with fentanyl, rocuronium bromide andpropofol, and maintenance anaesthesia with isoflurane. Hewas positioned in the left lateral position and the surgerywas uneventful. Prior to chest closure, an extrapleuralcatheter was sited in the right T3/4 interspace using an 18Gneedle. Upon extubation and transferral to the recoveryroom, a 10 mL/h infusion of 0.125% racemic bupivacainewas started. Around 1 hour later, he was observed to havemarked vasodilation of his left (contralateral) side of hisface that had a well-defined midline demarcation; theerythema was localised to the upper part of his face. After2 hours, the flushing had subsided.

Author comment: "This is the first description of harlequinsyndrome after extrapleural injection of local anaesthetic."Tyrrell JRJ, et al. Harlequin syndrome after extrapleural bupivacaine infusion.British Journal of Anaesthesia 109: 295-296, No. 2, Aug 2012. Available from:URL: http://dx.doi.org/10.1093/bja/aes245 - United Kingdom 803076728

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Reactions 8 Sep 2012 No. 14180114-9954/10/1418-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved