LipidRescue™ Resuscitation

Patient presents for shoulder surgery, Interscalene catheter inserted and 200mg ropivacaine given at 10:15, in PACU clearly not working so a furter 150mg given via catheter at 12:15. No inprovement in patients pain so a single shot block preformed at 12:55 and 350mg ropivacaine administered. All boluses of ropivacaine done with aspiration every 5 mims. Blocks performed using nerve stimulation. At 13:16 reported bizare behaviour with trashing legs and patient saying he could not stop. His behaviour can only really be described as bizare, sometimes able to talk, to observers seemed to be voluntary behaviour. Seemedto improve but reccured agin. 500 ml of intralipid given at 1500hrs within a very short time patient became normal and recounted to us how he was unable to control what he was doing or saying. I assume he must have some cerebral irritation from his large overdose. Clearly he should not have been given that amount of Ropivacaine. He weighs 70Kg

He kept sying I cant stop it wont stop when we asked him about his shaking limbs. It took me a long time to think of a seizure prodrome because he appeared to be awake. his limbs only intermitently shook hid left arm onl shook when his BP was taken and the cuff squeezed his arm
No I'm going to ESRA

I would be interested to hear what a neurologist would add. I like your original description of 'cerebral irritation' and recommend you consider submitting the case as a report or letter to the editor. It is extremely interesting by virtue of the presentation, the persistence of symptoms (hours), their rapid resolution after lipid infusion and the patient's ability to recount his perception of the CNS irritability. If you don't mind saying, in what country are you located? I will be presenting at the ESRA 2008.
guy