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Local Toxicity at Ambulatory Surgery Center after anesthesiologist performed right intra-scalene block on 62 year old male, ASA 2 (NIDDM), BMI 27.9. 2 minutes after completion of right intrascalene block, patient became symptomatic with ventricular arrhythmias.. Patient maintained BP and pulse throughout most of the rescussitation. Lipids 20% bolus 150 ml (91.6 kg) was given followed by lipid drip. During the rescussitation, patient was also given, Magnesium 1 GM, Versed, esmolol, propofol, 2 additional bolus of lipids 150 ml. He had to be defibrillated once for V-tach and returned to SR. He was transferred to ICU and placed on a Vent and with lipid drip.
January 23, 2017 | Unregistered CommenterDonna Moore
Hi Donna, Thanks very much for posting. I think it's especially scary for practitioners when severe LAST or a any life-threatening emergency for that matter, occurs in an ambulatory center if it's not in, or very close to a hospital. I know...I've been there. It sounds like everything was handled appropriately. Can you tell us when the cardioversion was used in relation to the lipid (before or after) and whether resolution of arrhythmias and return of spontaneous circulation was temporally related to administration of lipid? Finally, remember when continuing the drip it's important to remember there's an upper limit to dosing lipid .... so we have to remember to turn it off.
February 5, 2017 | Registered Commenter[Guy Weinberg]