Reactions 1183 - 5 Jan 2008

Clonidine/ropivacaine

Paradoxical breathing, tachycardia and tachypnoeain an elderly patient: case report

A 78-year-old man, who had obstructive lung disease,chronic renal failure, hypertension and lung cancer, wasscheduled for osteosynthesis of his humerus. He received aninterscalene block with 28mL of 0.5% ropivacaine andclonidine 0.15mg [dosage not clearly stated]. After 45 minutes,he developed paradoxical breathing, tachycardia(120 beats/min) and mild tachypnoea (23 breaths/min). Lungexamination showed reduced breathing sounds at the base ofhis lungs; his oxygen saturation was 91%. His fraction ofinspired oxygen was increased to 50%. During this time, hewas responsive and did not report dyspnoea. His saturationimproved and, 45 minutes later, 180 minutes after the block,his paradoxical breathing resolved.

Author comment: "Paradoxical breathing is uncommonexplicated in this case only by bilateral paralysis of thediaphragm."Dafni F, et al. A case of paradoxical breathing after upper arm surgery. RegionalAnesthesia and Pain Medicine 32 (Spec. issue 1): 111 abstr. 375, No. 5, Sep-Oct2007 [abstract] - Greece 801095030

1

Reactions 5 Jan 2008 No. 11830114-9954/10/1183-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved