Post Your Cases > Lipid treatment of LA toxicity in parturient.

18yo primagravida with established epidural, early signs PIH (raised BP, +proteinuria) given top-up for CSection (foetal distress) - Bupivacaine 0.5% 10ml. Prior aspiration of catheter negative for blood/CSF, but post-injection showed free aspiration venous blood. Patient became obtunded and seized, BP increased 150/110 with tachcardia 120bpm. Given oxygen, airway support and crash cart called for. While waiting, Intralipid 20% 100ml given as bolus as fear of progression to cardiac toxicity. Within 30 seconds patient conscious, responsive, and cardiovascularly stable. Stat CSection uneventful (GA) - baby APGARS 0(1) 7(5) !0(10).
Mother and baby discharged home and well to date.

I believe that catheter migration led to LA toxicity, and that the decision to try lipid early allowed prevention of progression to cardiac toxicity.

I'm a convert....
January 22, 2007 | Unregistered CommenterDr Andrew Spence
Thank you Dr. Spence for the wonderful case description. The eyewitness account is extremely valuable in terms of understanding the context in which LA toxicity occurs, the symptoms one is likely to see and the rapdity of response to lipid infusion. In addition to congratulating Dr. Spence for acting so quickly and possibly avoiding progression to a more serious toxic event, I also extend my thanks for his willingness to post the case and by sharing his experience, enriching all of ours'. Thanks for being the first to post a case here.
-Guy
January 27, 2007 | Registered Commenter[Guy Weinberg]