Reactions 819 - 16 Sep 2000

Bupivacaine/fentanyl

Hypoglycaemia and hypotension in a patient withdiabetes mellitus following intrathecaladministration: case report

Acute hypoglycaemia and hypotension occurred in a26-year-old pregnant woman with gestational diabetesmellitus during opioid analgesia with bupivacaine and fentanylfor labour and delivery at 38 weeks’ gestation.

The woman received combined spinal-epidural anaesthesiawith intrathecally administered bupivacaine 1.25mg andfentanyl 25µg. She then received a test dose of lidocaine andepinephrine [adrenaline] via an epidural catheter.Approximately 2 minutes later, and while remaining in a seatedposition, her HR suddenly rose to 138 beats/min. During thesubsequent replacement of the epidural catheter, shesuddenly felt dizzy and became diaphoretic and pale and herBP decreased to 62/48mm Hg. She had sinus tachycardia witha HR between 140 and 146 beats/min.

The woman was placed in a supine position and treated withoxygen, IV fluids and ephedrine. Her BP increased to112/53mm Hg, but she continued to experience dizziness andfelt faint. Her blood glucose level was found to be low at 57mg/dl; 1 hour before spinal-epidural anaesthesia, her bloodglucose level had been 121 mg/dl. Dextrose was immediatelyadministered and her blood glucose level increased to 128 mg/dl. She became asymptomatic and subsequently delivered ahealthy infant under analgesia.

Author comment: ‘The cause of acute hypoglycemia and itsrelation, if any, to profound hypotension after CSE [combinedspinal-epidural anaesthesia] is unclear. We speculate that theabrupt decrease in the levels of catecholamines and cortisolassociated with the rapid onset of analgesia from intrathecalopioids may have triggered these rare events in this patient.’Crites J, et al. Acute hypoglycemia following combined spinal-epidural anesthesia(CSE) in a parturient with diabetes mellitus. Anesthesiology 93: 591-592, Aug2000 - USA 800844181

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Reactions 16 Sep 2000 No. 8190114-9954/10/0819-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved