Reactions 487 - 5 Feb 1994

Bupivacaine

Seizures following intra-arterial injection in anelderly patient: case report

A 78-year-old woman experienced a generalised tonic-clonic seizure immediately after an inadvertent intra-arterialinjection of bupivacaine 6mg during the excision of a carotidbody tumour under local anaesthetic.

Adequate anaesthesia had initially been achieved withbupivacaine 100mg mixed with ornipressin 3U infiltrated atthe anterior border of sternomastoid. However, the patientcomplained of pain 1 hour later and the supplementary dose ofbupivacaine was given after a negative aspiration test. She thendeveloped the generalised tonic-clonic seizures.

The patient was given 100% oxygen, thiopental sodium andsuxamethonium chloride. She was intubated and ventilatedwith nitrous oxide and oxygen. Within 5 minutes, she startedto breathe spontaneously. Surgery was successfully completedand, at 6-weeks’ follow-up there were no sequelae.

Author comment: ‘The clinical history suggests that theconvulsion was due to direct intra-arterial injection ofbupivacaine . . . The importance of injection site in localanaesthetic toxicity is illustrated by this case.’Brooker CD, et al. Convulsions following bupivacaine infiltration for excision ofcarotid body tumour. Anaesthesia and Intensive Care 21: 877-878, Dec 1993 -Australia 800238205

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Reactions 5 Feb 1994 No. 4870114-9954/10/0487-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved