Reactions 1514, p36-37 - 16 Aug 2014

SRopivacaine

Delayed arousal: case reportA 71-year-old man experienced delayed arousal following

ropivacaine administration.The man was indicated for a gastrectomy. For inducing

general anaesthesia, a catheter was placed; however followingblood aspiration a re-transplantation was done. She receivedvarious anaethetics and 15 minutes prior to the surgery, 4ml of0.375% ropivacaine was drawn into a 20ml syringe andadministered. He received a total of 15 mL of 0.375%ropivacaine at intervals of approximately 1 hour during thesurgery. Later, 30 minutes prior to surgery end a continuouswas started to provide epidural anaesthesia (288mL of 0.2%ropivacaine, and 900µg of fentanyl for a total of 300mL) at acontinuous rate of 4 mL/hour. He received a total of 58.13mgropivacaine. One hour post surgery start, he experienced signsof sinus tachycardia with the pulse increasing to 100bpm. Hereceived treatment for the same however tachycardia didn’tresolve. Surgery time was 3 hours and 8 minutes. Albuminlevel decreased to 2.6 g/dL post surgery. Immediately postsurgery, there were signs of spontaneous respiration and hewas treated with neostigmine. Respiration andhaemodynamics were stable, and he showed reflexes andavoidance response to tracheal suctioning stimulation.Movement of upper and lower limbs were also observed, butthere were no signs of him opening his eyes spontaneously, ora respiratory response. naloxone was administered to enhanceawakening, but there was no change in status. On aspiration ofcatheter, bloody fluid was seen, suggesting that the catheterhad entered a blood vessel. Disturbance of consciousness anddelayed arousal due to toxicity from local anaesthetics wassuspected.

Ropivacaine was withdrawn immediately and the manreceived soya oil emulsion [lipid emulsion] as treatment oftoxicity. Thereafter, his respiration and haemodynamicsbecame stable. He was kept under observation. He opened hiseyes on his own ≈2 hours post conclusion of surgery, allowingextubation. Pain control was performed with NSAIDS andfentanyl. Tachycardia with a pulse of around 110 bpm and mildhypertension with a BP of 150/90 mmHg continued for about5 hours thereafter. Post surgery he was shifted to a high careunit.

Author comment: Suspecting that the epidural cathetermight have moved, a 5 mL syringe was used to aspirate thecatheter and a bloody fluid continued to be aspiratedsuggesting that the catheter had entered a blood vessel. Wetherefore suspected that the patient was suffering fromdisturbance of consciousness and delayed arousal due totoxicity from local anaesthetics.Akimoto K, et al. A case of delayed arousal after anesthesia due to aberrantepidural catheter placement in a blood vessel. . Masui. The Japanese Journal ofAnesthesiology 63: 814-816, No. 7, Jul 2014 [Japanese; summarised from anEnglish translation] - Japan 803106784

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Reactions 16 Aug 2014 No. 15140114-9954/14/1514-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved