Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Gola, Wojciech, Bialka, Szymon, Zajac, Marek, Misiolek, Hanna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
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
_version_ 1784809156015816704
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
work_keys_str_mv AT golawojciech cardiacarrestaftersmalldosesropivacainelocalanestheticsystemictoxicityinthecourseofcontinuousfemoralnerveblockade
AT bialkaszymon cardiacarrestaftersmalldosesropivacainelocalanestheticsystemictoxicityinthecourseofcontinuousfemoralnerveblockade
AT zajacmarek cardiacarrestaftersmalldosesropivacainelocalanestheticsystemictoxicityinthecourseofcontinuousfemoralnerveblockade
AT misiolekhanna cardiacarrestaftersmalldosesropivacainelocalanestheticsystemictoxicityinthecourseofcontinuousfemoralnerveblockade