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Cardiac Arrest after Small Doses Ropivacaine: Local Anesthetic Systemic Toxicity in the Course of Continuous Femoral Nerve Blockade
Background: The paper presents a case report of an episode of local anesthetic systemic toxicity (LAST) with cardiac arrest after continuous femoral nerve blockade. Case report: A 74-year-old patient burdened with hypertension and osteoarthritis underwent elective total knee replacement surgery. Aft...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9566458/ https://www.ncbi.nlm.nih.gov/pubmed/36231524 http://dx.doi.org/10.3390/ijerph191912223 |
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author | Gola, Wojciech Bialka, Szymon Zajac, Marek Misiolek, Hanna |
author_facet | Gola, Wojciech Bialka, Szymon Zajac, Marek Misiolek, Hanna |
author_sort | Gola, Wojciech |
collection | PubMed |
description | Background: The paper presents a case report of an episode of local anesthetic systemic toxicity (LAST) with cardiac arrest after continuous femoral nerve blockade. Case report: A 74-year-old patient burdened with hypertension and osteoarthritis underwent elective total knee replacement surgery. After surgery, a continuous femoral nerve blockade was performed and an infusion of a local anesthetic (LA) was started using an elastomeric pump. Five hours after surgery, the patient had an episode of generalized seizures followed by cardiac arrest. After resuscitation, spontaneous circulation was restored. In the treatment, 20% lipid emulsion was used. On day two of the ICU stay, the patient was fully cardiovascularly and respiratorily stable without neurological deficits and was discharged to the orthopedic department to continue treatment. Conclusion: Systemic toxicity of LA is a serious and potentially fatal complication of the use of LA in clinical practice. It should be noted that in nearly 40% of patients, LAST deviates from the classic and typical course and may have an atypical manifestation, and the first symptoms may appear with a long delay, especially when continuous blockades are used. Therefore, the proper supervision of the patient and the developed procedure in the event of LAST is undoubtedly important here. |
format | Online Article Text |
id | pubmed-9566458 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-95664582022-10-15 Cardiac Arrest after Small Doses Ropivacaine: Local Anesthetic Systemic Toxicity in the Course of Continuous Femoral Nerve Blockade Gola, Wojciech Bialka, Szymon Zajac, Marek Misiolek, Hanna Int J Environ Res Public Health Case Report Background: The paper presents a case report of an episode of local anesthetic systemic toxicity (LAST) with cardiac arrest after continuous femoral nerve blockade. Case report: A 74-year-old patient burdened with hypertension and osteoarthritis underwent elective total knee replacement surgery. After surgery, a continuous femoral nerve blockade was performed and an infusion of a local anesthetic (LA) was started using an elastomeric pump. Five hours after surgery, the patient had an episode of generalized seizures followed by cardiac arrest. After resuscitation, spontaneous circulation was restored. In the treatment, 20% lipid emulsion was used. On day two of the ICU stay, the patient was fully cardiovascularly and respiratorily stable without neurological deficits and was discharged to the orthopedic department to continue treatment. Conclusion: Systemic toxicity of LA is a serious and potentially fatal complication of the use of LA in clinical practice. It should be noted that in nearly 40% of patients, LAST deviates from the classic and typical course and may have an atypical manifestation, and the first symptoms may appear with a long delay, especially when continuous blockades are used. Therefore, the proper supervision of the patient and the developed procedure in the event of LAST is undoubtedly important here. MDPI 2022-09-27 /pmc/articles/PMC9566458/ /pubmed/36231524 http://dx.doi.org/10.3390/ijerph191912223 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Case Report Gola, Wojciech Bialka, Szymon Zajac, Marek Misiolek, Hanna Cardiac Arrest after Small Doses Ropivacaine: Local Anesthetic Systemic Toxicity in the Course of Continuous Femoral Nerve Blockade |
title | Cardiac Arrest after Small Doses Ropivacaine: Local Anesthetic Systemic Toxicity in the Course of Continuous Femoral Nerve Blockade |
title_full | Cardiac Arrest after Small Doses Ropivacaine: Local Anesthetic Systemic Toxicity in the Course of Continuous Femoral Nerve Blockade |
title_fullStr | Cardiac Arrest after Small Doses Ropivacaine: Local Anesthetic Systemic Toxicity in the Course of Continuous Femoral Nerve Blockade |
title_full_unstemmed | Cardiac Arrest after Small Doses Ropivacaine: Local Anesthetic Systemic Toxicity in the Course of Continuous Femoral Nerve Blockade |
title_short | Cardiac Arrest after Small Doses Ropivacaine: Local Anesthetic Systemic Toxicity in the Course of Continuous Femoral Nerve Blockade |
title_sort | cardiac arrest after small doses ropivacaine: local anesthetic systemic toxicity in the course of continuous femoral nerve blockade |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9566458/ https://www.ncbi.nlm.nih.gov/pubmed/36231524 http://dx.doi.org/10.3390/ijerph191912223 |
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