Post Your Cases > Adductor Canal Block LAST Arrest

32 year old, 79kg very fit male presents for ACL reconstruction.
He had just swam 5km that morning.
Allergies Augmentin
PHX: Mild asthma; Meds: Symbicort BD
IV access, oxygen, midazolam, ketamine, fentanyl (small doses) and patient saturating well and conversing
Dynamic ultrasound guided ACB with 100mm needle, 30ml 0.75% Naropin
Needle tip seen at all times during injection distant from artery
Drew back every 5ml and no blood
Towards end of injection patient vocalised and developed head tremor before having tonic/clonic siezure
Wheeled 3m into operating theatre and given 4mg midazolam for ongoing siezures
No output, CPR, coarse VF, biphasic shock 150J
Adrenaline/CPR/ACLS - asystolic
Intralipid 100ml bolus and repeated 4 minutes later
Intralipid infusion
14 minutes of CPR in total and regained spontaneous circulation
Transferred to ICU intubated
Intralipid infusion ceased and CVS stable
Cooled for 24 hours for cerebral protection
Extubated post cooling
STM loss around event
2 weeks later back to work half days
Continues to improve
February 26, 2019 | Unregistered CommenterDr Andrew Wallis