Reactions 1409 - 7 Jul 2012

Ropivacaine

Drug toxicity treated with soya oil emulsion in anadolescent: case report

A 16-year-old boy developed ropivacaine toxicity duringgeneral anaesthesia for right shoulder arthroscopy andBankart procedure; he was treated with soya oil emulsion[Intralipid].

The boy received two 20mL injections of 0.75%ropivacaine into the spine at C5 and C6, respectively (totaldose of 40mL of 0.75% ropivacaine) following sedationwith IV midazolam. He became confused, developedslurred speech and a slight intention tremor in his left armand reported visual hallucinations (purple spots)10 minutes after the motor and sensory block. Hisrespiration rate, heart rate and blood pressure all increased.Ropivacaine toxicity was suspected.

A bolus infusion of Intralipid was administered alongsideIV midazolam. Intralipid was then continued for the next3 hours. The boy’s symptoms subsequently resolved over20–30 minutes. General anaesthesia was maintained withpropofol and sevoflurane and he underwent an uneventfulprocedure and postoperative recovery. He remained wellwhen contacted 1 month postsurgery.

Author comment: "We believe that the observedsymptoms were the result of ongoing systemic absorption ofthe drug. The administered dose of ropivacaine was5.3 mg/kg which can be considered in the toxic range for abrachial plexus block (4-8 mg/kg). Other factors may haveplayed a role in the development of toxicity". These factors"include the high vascularity associated with the interscaleneapproach, the lean body mass of the patient and potentiallyhis ADHD diagnosis".Al-Alami AA. Successful treatment of early ropivacaine toxicity with intralipid ina patient with attention deficit hyperactivity disorder. Middle East Journal ofAnesthesiology 21: 427-9, No. 3, Oct 2011 - USA 803072718

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Reactions 7 Jul 2012 No. 14090114-9954/10/1409-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved