Systemic ropivacaine toxicity from a peripheral nerve infusion in a medically complex patient - 24/05/15
: Assistant Professor of Anesthesiology, Corrie Anderson, MD, FAAP : Professor of Anesthesiology, Martha Pankovich, MD : Assistant Professor of Anesthesiology, Lizabeth Martin, MD : Assistant Professor of Anesthesiology, Sean Flack, MBChB, FCA : Professor of AnesthesiologyAbstract |
This is a case of systemic ropivacaine toxicity from a sciatic nerve catheter. A 20-year-old patient after heart transplant with poor systemic perfusion on hemodialysis and multiple medications experienced local anesthetic systemic toxicity 72 hours after placement of a peripheral nerve catheter. The case demonstrates the potentially significant impact of medical comorbidities on system absorption of local anesthetics and reinforces that existing dose guidelines are not evidence based, and literature to guide local anesthetic bolus supplementation of continuous infusions is scant.
Le texte complet de cet article est disponible en PDF.Highlights |
• | A case of local anesthetic systemic toxicity in a medically complex patient. |
• | The patient had multiorgan failure including cardiac, hepatic, and renal. |
• | A first lower extremity amputation with peripheral nerve catheters was uneventful. |
• | A second amputation with nerve catheters resulted in systemic toxicity. |
• | The case suggests that local anesthetic dosing should be altered in sick patients. |
Keywords : Patient safety, Plasma concentration, Ropivacaine, Sciatic block, Toxicity
Plan
| ☆ | Conflict of interest: None of the authors has a conflict of interest with the submission. |
| ☆☆ | Financial support: No financial support was received for this submission. |
| ★ | Informed consent: The patient gave verbal and written consent for publication of the report. |
| ★★ | Institutional review board: Seattle Children's Institutional Review Board, 4800 Sand Point Way NE, CW8-5A, Seattle, WA 98105. Tel.: +1 206 987 7804; fax: +1 206 884 2635. Email: irb@seattlechildrens.org. |
Vol 27 - N° 4
P. 338-340 - juin 2015 Retour au numéro
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