LipidRescue™ Resuscitation

The patient was a lady in her mid 30’s (BMI 24.2) who required a routine Cesarean section for obstetric reasons. She was ASA grade 1 and consented to an RCT to study the efficacy of transversus abdominis plane block post intrathecal anesthesia. After uneventful anesthesia (bupivacaine 10 mg + sufentanil 5 microg) and uneventful surgery (newborn Apgar 10/10) she was randomized to have bilateral TAP blocks. She was given 20 ml of levobupivacaine 3.75 mg/ml on each side with continuous EKG monitoring and realtime ultrasound guidance. Everything was uneventful and the lady was taken to our recovery room. About 10 minutes later the patient became unresponsive and had a tonic-clonic seizure which lasted two minutes. We immediately gave her bag mask ventilation with 100% oxygen. Because of the recent TAP block and seizure, we treated her for LAST with 100ml bolus of Intralipid 20% and an infusion was started. Within five minutes, spontaneous breathing had recovered and she had a second seizure which we treated with IV benzodiazepine with the Intralipid continuing (0.25 ml/kg/min). BP, EKG and pulse were all fine throughout. She recovered fully in three hours and had a MRI a couple of hours later. The MRI brain scan and blood count and electrolyte tests were normal. A levobupivacaine level was taken just before the MRI and came back with a plasma concentration of 0.31 ng/ml. The patient went home on the 3rd post-operative day having made a full recovery.