LipidRescue™ Resuscitation

59 y.o. ASA II 90 kg male for shoulder arthroscopy at a surgery center. Pt. received Fentanyl 50 mcg, Versed 2 mg IV for sedation. Baseline BP 123/65, HR 65-70. Nerve stimulator used to .4mA with good biceps response. 40 cc 0.5% Bupivicaine given via 22G 50mm Braun stimuplex needle slowly with negative aspiration every 5 cc; a flash of blood was noted on withdrawal of the needle. Pt was responsive to voice until the end of the procedure, his heart rate had increased to 85 bpm, NSR. While trying to get a response from the patient, he began seizing (20 seconds after completion of block) Sinus tach at 145 noted, good pulse, intralipid started immediately by IV infusion. Patient continued to seize, and received an additional 2mg Versed, 125mg Pentothal and a total of 250 cc intralipid. Seizures resolved after Pentothal given. Pt. was breathing spontaneously throughout, assisted with O2 via ambu bag/mask. Cardiac rhythm remained sinus tachycardia throughout, with peak BP 185/93, returning to 120s/70s with HR 95. Patient required 60 minutes to awaken, was very confused initially, and required another 2 hours to return to baseline neurologic status. Interestingly, after the first hour the patient had very little block, but by the end of the second hour he could move only his fingers. Because of the length of time to return to baseline neurologically, surgery was postponed.

I forgot to mention that I performed the same block (same procedure, medication, dose) on this same patient's other shoulder 18 months previous to this with no adverse reaction.