Reactions 644 - 29 Mar 1997

SMepivacaine overdose

Seizures in a child: case reportA 3-year-old girl experienced seizures during epidural

anaesthesia with mepivacaine and general anaesthesia withsevoflurane.

The girl was diagnosed with an adrenal neuroblastoma andscheduled for adrenalectomy. Anaesthesia was induced usingthiopental sodium and she was intubated using vecuroniumbromide. Anaesthesia was then maintained with oxygen,nitrous oxide and sevoflurane. During 7 hours of anaesthesia,she received a total of mepivacaine 450mg; the drug was givenintermittently in divided doses of 5ml of 1% mepivacaine via anepidural catheter.

Approximately 30 minutes after the last dose ofmepivacaine, the operation was completed and sevofluranewas stopped. Approximately 5 minutes later, the girl emergedfrom anaesthesia. She experienced a generalised seizurebefore extubation and was treated with IV thiopental sodium.She experienced another seizure 20 minutes later and wastreated with thiopental sodium and sevoflurane in oxygen.Tests showed metabolic acidosis which was treated withhyperventilation and sodium bicarbonate. Inhalation ofsevoflurane was continued for 2 hours.

The girl regained consciousness and did not experience anyfurther seizures. She was diagnosed with mepivacaineintoxication because her plasma mepivacaine concentrationwas 7.7 µg/ml immediately after her first seizure.

Author comment: ‘In children, mepivacaine intoxicationassociated with regional anaesthesia has not been reported, toour knowledge . . . Because general anaesthesia conceals theperception of pain or paresthesia, it increases not only the riskof neurological damage but also the risk of misplacement ofepidural catheter . . . In this case, we suggest that the cause oftoxicity in our patient was the cumulative effect of mepivacaineadministration epidurally. Repeated doses were requiredbecause of inadequate analgesia possibly associated withepidural catheter misplacement leading to an overdose.’ Thispatient’s seizures were probably suppressed by sevofluraneanaesthesia.Saitoh K, et al. Convulsions associated with epidural analgesia during sevofluraneanaesthesia. Pediatric Anesthesia 6: 495-497, No. 6, 1996 - Japan 807121373

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Reactions 29 Mar 1997 No. 6440114-9954/10/0644-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved