LipidRescue™ Resuscitation

Healthy 35 yo female, ASA 1 (65in, 194lbs: IBW 125lbs) with documented egg allergy (unknown reaction), underwent MAC for excision of breast mass. Uncomplicated OR case 45min: sedation with midazolam 2mg, fentanyl 50mcg, and propofol. Zofran given near end of case. 40cc of 1% lidocaine w/o epi administered for local anesthesia by surgeon at beginning of case, with aspiration every 5cc confirming that injection was not intra-vascular. During transfer with CRNA to PACU, per report, the patient began having jerking motions of the upper and lower extremities lasting 10-20 seconds. Patient was awake and apologetic for these movements, as it seemed to be out of her control. Upon arrival to PACU patient noted to be "agitated" by receiving nurse. Anesthesiologist evaluation in PACU confirmed jerking motions in extremities lasting approx 10seconds with 30sec-2min of inactivity, patient was conscious but sleepy. As the episodes progressed her mental status appeared to be waning. No vitals were recorded, but she was noted to be tachycardic in the 110s and sating well on 2L NC. A diagnosis of local anesthetic induced CNS toxicity was suspected. Within 3 minutes a bolus of 120cc of 20% intralipid was administered over 15min via 22G PIV. Vitals at this time were and remained stable, patient was sleepy A+Ox2 improving to A+Ox3 by the end of the bolus. Infusion of 0.25cc/kg/min was given over 1 hour and neurology consultation obtained. Neurology agreed, that this was likely CNS toxicity and not a seizure episode given patient recollection of event, no post-ictal period, and resolution with intra-lipic therapy. Symptoms completely resolved and patient was monitored in PACU for 5 hours prior to discharge home with family.