Reactions 860 - 14 Jul 2001

SBupivacaine/lidocaine

Pulmonary oedema in an elderly patient: case reportPulmonary oedema occurred in a 77-year-old woman after

she received local anaesthesia with bupivacaine and lidocaineduring phacoemulsification and intraocular lens implantation.She had a history of atrial fibrillation, hypertension andmyocardial infarction, and she was also taking bumetanide,trandolapril, aspirin and nitroglycerin [glyceryl trinitrate].

Prior to surgery, the woman had not fasted and she wasadvised to miss her morning dose of bumetanide. The womanreceived a peribulbar block, using the inferotemporalapproach, with lidocaine 2% and bupivacaine 0.5%. Surgeryproceeded uneventfully, but 5 minutes into recovery, shedeveloped difficulty breathing, and she became cyanosed,tachypnoeic and tachycardic. Pulse oximetry readings were <80%, despite receipt of oxygen. Pink frothy sputum wasproduced upon coughing.

The woman’s condition worsened rapidly during thefollowing few minutes, and she required tracheal intubationand lung ventilation. Treatment included administration ofpropofol, suxamethonium chloride and furosemide. A chest x-ray revealed pulmonary oedema. Diamorphine and midazolamwere administered for sedation.

The woman’s condition improved over the next 2 hoursfollowing good diuresis, and she was extubated.Echocardiography showed that her pre-existing left ventriculardysfunction had worsened significantly. Abnormal thyroidfunction was also observed, leading to a diagnosis ofthyrotoxicosis. Treatment with carbimazole was started. Oneday later, she was asymptomatic, and she was discharged onhospital day 3.

Author comment: ‘Pulmonary oedema occurring afterperibulbar anaesthesia has been described, but not in anunfasted patient undergoing elective surgery. The withholdingof the diuretic before the operation raises another issue in theperi-operative management of ophthalmic anaesthesia.’Taylor I, et al. Pulmonary oedema after ophthalmic regional anaesthesia in anunfasted patient undergoing elective surgery. Anaesthesia 56: 444-446, May 2001 -England 800865998

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Reactions 14 Jul 2001 No. 8600114-9954/10/0860-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved