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Pt. Background: 60 kg, Female, Pulm. Hypertension PAP 40mmHG, Sjogren`s syn, Raynaud Syn, Hypothyroid, Mild MR and TR, resonable exercise tolerance.
Posted for Thumb fusion under Axillary plexus block.
She did not want any sedation or GA as she has a fear of not waking up. She wanted to abandon the procedure if the block did not work.
Axillary plexus block was done after all the safety checks and precautions. Total of 20 mls of 2%Lignocaine with Adrenaline was adminitered. Performed by Consultant Anaesthetist under ultrasound and pressure monitor with a 360 Stimuplex needle 50mm with aspiration for blood every ml. Good sensory and motor block was acheived in the next 5 min. Pt complained of lightheadedness, blurring of vision( cannot see the numbers on the monitor), difficulty in swallowing, shivering and hyperventilating. Haemodynamically stable HR 75/min and BP 150/78 mmHg.
Diagnosis of LA toxicity was made and treated with a bolus of 100 mls Intralipid 20%. Followed by a infusion of 900ml/hr. Quick recovery in the next 10 min with vision becoming normal first and then shivering stopped and she became less anxious. Difficulty in swallowing was the last to improve which took around 30 min.
Decision to go ahead with the procedure taken after discussion with patient and surgeon.
Procedure underwent uneventfully. HDU informed but no beds. Plan: extended recovery stay, continue Intralipid infusion for 4hrs from performance of block and stay overnight in Hospital.
NPSA, GP letter and critical incident reporting done.
January 25, 2016 | Unregistered CommenterKiran Polisetty
Good case, Kiran, and managed very well. Thanks for posting.
April 10, 2016 | Registered Commenter[Guy Weinberg]