Post Your Cases > Lipid rescue for ropivacaine toxicity

A 68year old male , 75kg for ORIF wrist had an infraclavicular brachial plexus block, under PNS , awake, sedated with midazalom and clonidine. +/-40 seconds later, he became unresponsive, restless, and proceeded to a full tonic clonic seizure, followed by PEA broad complex QRS ( regular 100- 120bpm)
CPR done for a minute while we intubated, called for help and defibrillator, fortunately cardiac output returned. ABG done ph 6.8
Still hypotensive despite boluses of adrenaline, eventually settled with adrenaline infusion, transfer to icu, and managed intubated overnight. In theatre we opted to give a 100mls intralipid 20% over 10min, and repeated the dose (100mls) 15 minutes later. He had a further 3rd dose in ICU . Extubated next day, free of neurological sequale. Had a GA 3 days later for ORIF
August 10, 2010 | Unregistered Commentervish lekha
glad that the patient recoved and was neurologically intact - good CPR, no doubt. the pH would be particularly worrisome to me in terms of predicting recovery. can you specify whether each/any 100mL lipid infusion caused a change in clincal status?
g
August 12, 2010 | Registered Commenter[Guy Weinberg]