Post Your Cases > LA toxicity or Eclamptic seizure in a Parturient
27 year old of Sri-Lankan origin and who did not speak English and weighed ~60kg. Epidural sited for labour, OP position baby and had 100mg bupivicaine over 4 hour period. Eventually had a spontaneous delivery of a healthy baby but then had a 3rd degree tear. She was taken to theatre for a repair, and given 50mg bupivicaine (10ml 0.5%) bolus after a negative aspitration. With her limited english , she said 'water', which I refused her. Her BP was 160/90. She then had a sudden loss of consciousness, and had a grand-mal seizure. A crash call was made. I gave her oxygen and 50mg of thiopentone, which stopped the seizure, followed by 300mg thiopentone and 100mg suxemethonium and intubated her. I aspirated the epidural catheter with a 3ml syringe and venous blood was found. We started a magnesium infusion as she was hypertensive and had proteinuria. We decided to give intra-lipid 100mg bolus followed by an infusion although there were no signs of cardiac toxicity, as a preventative measure. The tear was repaired and she was extubated at the end of the case. She remained stable post-operatively.
We believe there may have been catheter migration as the patient positioned herself from her bed to the operating table. When she was asking for water, it may have been signs of peri-oral tingling. By treating her early with intralipid, we may have prevented cardiac toxicity.
Epidural sited for labour, OP position baby and had 100mg bupivicaine over 4 hour period. Eventually had a spontaneous delivery of a healthy baby but then had a 3rd degree tear.
She was taken to theatre for a repair, and given 50mg bupivicaine (10ml 0.5%) bolus after a negative aspitration. With her limited english , she said 'water', which I refused her. Her BP was 160/90.
She then had a sudden loss of consciousness, and had a grand-mal seizure. A crash call was made. I gave her oxygen and 50mg of thiopentone, which stopped the seizure, followed by 300mg thiopentone and 100mg suxemethonium and intubated her.
I aspirated the epidural catheter with a 3ml syringe and venous blood was found.
We started a magnesium infusion as she was hypertensive and had proteinuria. We decided to give intra-lipid 100mg bolus followed by an infusion although there were no signs of cardiac toxicity, as a preventative measure.
The tear was repaired and she was extubated at the end of the case. She remained stable post-operatively.
We believe there may have been catheter migration as the patient positioned herself from her bed to the operating table. When she was asking for water, it may have been signs of peri-oral tingling. By treating her early with intralipid, we may have prevented cardiac toxicity.