Reactions 1442 - 9 Mar 2013

SRopivacaine

Total spinal anaesthesia, cardiac arrest andparaplegia following accidental subarachnoidadministration: case report

A 21-year-old pregnant woman developed total spinalanaesthesia, cardiac arrest and paraplegia after accidentalsubarachnoid administration during epidural injection ofropivacaine.

The woman, who was undergoing caesarean delivery,received epidural anaesthesia at L2–3 interspace consisting ofa 3mL test dose injection of 0.894% ropivacaine, followed by a7mL injection 5 minutes later. She had experiencedparaesthesia during catheter insertion. Ten minutes after thesecond injection, she developed extremity analgesia, and herBP and HR decreased. Simultaneously, she could not bearoused, and she developed cardiac arrest.

The woman immediately underwent CPR, ventilation andintubation. Her sinus rhythm recovered, and her BP and HRimproved, but 40 minutes later, she experienced anotherepisode of cardiac arrest. Following CPR, her sinus rhythm wasrestored; however, the fetal heart beat had disappeared, andthe operation was cancelled. Three days later, she regainedconsciousness, but had developed paraplegia belowT10 vertebra. Subsequently, her pain and temperaturesensation improved, but her lower extremity movement didnot.

Author comment: "In our opinion, the occurrence of totalspinal anesthesia indicated administration of 10mL 0.894%ropivacaine mesylate into the subarachnoid space. Therefore,it was possible that paraplegia was induced by the directspinal cord drug toxicity."Jiang X, et al. Ropivacaine-induced cardiac arrest and paraplegia after epiduralanesthesia. Minerva Anestesiologica 78: 1309-1310, No. 11, Nov 2012. Availablefrom: URL: http://www.minervamedica.it/en/journals/minerva-anestesiologica/article.php?cod=R02Y2012N11A1309 - China 803083992

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Reactions 9 Mar 2013 No. 14420114-9954/10/1442-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved