Reactions 1428 - 17 Nov 2012

SBupivacaine/lidocaine

Pulmonary oedema: case reportA 42-year-old man developed pulmonary oedema after

receiving bupivacaine and lidocaine.The man had a history of diabetes and hypertension, and

displayed features of retinopathy and nephropathy. Hereceived an injection of 10mL of an equal mixture of 0.5%bupivacaine and 2% lidocaine, administered at the infero-temporal and superior-nasal orbital margin, for thepurposes of inducing peribulbar block prior to vitreo-retinalsurgery. Complete akinesia of the eye was not achieved, sohe received an injection of a further 4mL of the localanaesthetic mixture 5 minutes later through an infero-temporal injection. Surgery was commenced; 30 minuteslater he had difficulty breathing, complained of uneasiness,starting producing copious secretions and he desaturated.He received oxygen but his hands suddenly becameclammy and cold, his pulse became "thready", he becameunresponsive and stopped breathing, and had generalisedtonic-clonic convulsions.

The man was received bag mask ventilation. Atropineand midazolam were administered to him. He wasintubated and received morphine and furosemide. After20 minutes, spontaneous respiration returned. Heresponded to verbal commands after 90 minutes. He wasventilated overnight in an ICU. Chest x-ray indicatedpulmonary oedema. He was extubated the next day anddischarged on post-operative day 5.

Author comment: "The presentation of pulmonaryoedema in this case is suggestive of local anaesthetic toxicityfollowing the peribulbar block . . ."Chhabra A, et al. Pulmonary oedema in a patient undergoing vitreo-retinal surgeryunder peribulbar block. Indian Journal of Anaesthesia 56: 387-390, No. 4, Jul-Aug2012. Available from: URL: http://dx.doi.org/10.4103/0019-5049.10082 -India 803079799

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Reactions 17 Nov 2012 No. 14280114-9954/10/1428-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved