Reactions 1197 - 12 Apr 2008

SRopivacaine

Subarachnoid anaesthesia in an elderly patient:case report

A 69-year-old woman developed subarachnoid anaesthesiafollowing posterior brachial plexus block with ropivacaine.

The woman was scheduled for surgical excision ofmelanoma. For the first puncture space, a test dose of 0.5%ropivacaine 2mL was injected, followed by a further 7mL. Thesecond puncture space was approached; during injection of atest dose of 0.5% ropivacaine 2mL, she lost consciousness anddeveloped respiratory arrest, bradycardia and arterialhypotension.

The woman received orotracheal intubation, mechanicalventilation, atropine and ephedrine, resulting in completehaemodynamic and ventilatory stability. A neurologicalexamination revealed nonreactive bilateral mydriasis, theabsence of corneal, oculocephalic or ciliospinal reflexes, andthe absence of motility in response to pain in her extremities. ACT scan revealed a reduction in cerebral flow. She wastransferred to the emergency room without completion of theprocedure. Four hours after the block, a transcranialultrasound was completely normal. She was conscious butfollowed instructions with difficulty. A neurologicalexamination revealed severe bilateral hypoacusis and mobilityof her extremities with debility of her left arm. Seven hoursafter the incident, an MRI was completely normal. Shecompletely normalised after 8 hours. She mentioned that shehad felt nauseous during the procedure. She was extubatedand moved to the hospital the following day.Fernandez-Mere LA, et al. Spinal anesthesia after brachial plexus block with theposterior approach. Revista Espanola de Anestesiologia Y Reanimacion 55: 63-64,No. 1, Jan 2008 [Spanish; summarised from a translation] - Spain 801104284

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Reactions 12 Apr 2008 No. 11970114-9954/10/1197-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved