LipidRescue™ Resuscitation

The patient was a female with an uncomplicated medical history with an epidural in place (placed prior to foley bulb placement when she was 1 cm dilated) for previous 12 hours and taken to OR for caesarean section for non-reassuring fetal heart tracings. Epidural was bloused with total of 19ml of 2% lidocaine with epi (prior to OR, in OR, and post incision due to pain) and patient was stable throughout case. Due a lack of duramorph in the hospital, placed bilateral TAP blocks in OR at end of case with 30ml of 0.5% Marcaine. Postoperatively patient was doing well, w/o complaints of pain or nausea/vomiting. While transporting patient to PNU, patient noted that she felt like everything sounded funny like we were talking in a tunnel. I asked the patient about any funny tastes in her mouth and she reported that it did taste funny. Upon arrival to bed in PNU, patient noted difficulty with speech and movement but vitals o/w stable. Placed patient on 100% NRB and BP 134/71, HR 75, sats 100% and patient given reassurance at that time while symptoms abruptly resolved. After about 1-2 minutes, symptoms were returning so acquired 20% lipid emulsion, ICU notified and RT and ICU RN quickly arrived also at bedside, patient unable to move well, speak or open eyelids but responsive and vitals unchanged from above (vitals still stable). Administered 20% lipid emulsion at that time (1.5ml/kg bolus followed by 0.25ml/kg/min infusion). Gave a total of 500ml of 20% lipid emulsion (bolus plus infusion) and transported patient to ICU. ABG acquired by ICU RN prior to transport and showed a mild respiratory alkalosis (rapid RR) but o/w normal ABG, patient symptoms began improving prior to transport, given reassurance, instructed to take slow deep breaths and transported to ICU stable. Vitals post ICU arrival were HR 68, BP 151/78, sats 100% on 6L NRB. 12 lead EKG post arrival was also normal. Patient with return of normal speech and near resolution of symptoms but reported feeling tired at that time. Patient was stable in ICU with resolution of symptoms and later transferred from ICU back to PNU, doing well, no symptoms for about 4 hours, pain controlled, no complaints of nausea/icthiness or other complaints at that time. Patient stable post PNU arrival, vital signs stable, no residual numbness at that time from epidural. Otherwise uncomplicated hospital course.