57 year old male booked for revision rotator cuff repair of right shoulder.
Performed ultrasound guided nerve stimulator controlled low approach interscalene brachial plexus block in induction room under conscious sedation.Good view of the brachial plexus obtained with anterior deltoid twitch at 0.4mA with short bevel needle using in plane technique. Immediately following the 4th incremental injection after negative aspiration to a total of 20ml 0.75% ropivacaine the pt complained of not hearing me when asked if he felt ok, then became unresponsive followed immediately by a generalized tonic clonic seizure. A presumed diagnosis of LAST by inadvertent IV injection was made and help ( and intralipid rescue kit ) summoned. 100% O2 applied and iv midazolam given. Bolus of intralipid 20% 150 ml given stat.Seizure activity persisted. Induced with propofol and intubated following suxamethonium administration to protect airway and control ventilation. ECG showed normal sinus tachycardia with slight prolongation of QRS complex. repeat dose of intralipid 150ml given as bolus and infusion commenced. Patient transported to ICU for further supportive management . No hypotension or arrhythmias ensued. Normalisation of QRS complex and patient extubated 3 hours post event with no gross neurological deficit. He was discharged home the following day with no sequelae. At a post procedure visit he recalled suddenly not hearing me and a feeling that he was "about to die" I will present this case at our local group M&M and the hospital events meeting. Thanks
Performed ultrasound guided nerve stimulator controlled low approach interscalene brachial plexus block in induction room under conscious sedation.Good view of the brachial plexus obtained with anterior deltoid twitch at 0.4mA with short bevel needle using in plane technique. Immediately following the 4th incremental injection after negative aspiration to a total of 20ml 0.75% ropivacaine the pt complained of not hearing me when asked if he felt ok, then became unresponsive followed immediately by a generalized tonic clonic seizure. A presumed diagnosis of LAST by inadvertent IV injection was made and help ( and intralipid rescue kit ) summoned. 100% O2 applied and iv midazolam given.
Bolus of intralipid 20% 150 ml given stat.Seizure activity persisted. Induced with propofol and intubated following suxamethonium administration to protect airway and control ventilation. ECG showed normal sinus tachycardia with slight prolongation of QRS complex. repeat dose of intralipid 150ml given as bolus and infusion commenced. Patient transported to ICU for further supportive management . No hypotension or arrhythmias ensued. Normalisation of QRS complex and patient extubated 3 hours post event with no gross neurological deficit. He was discharged home the following day with no sequelae. At a post procedure visit he recalled suddenly not hearing me and a feeling that he was "about to die"
I will present this case at our local group M&M and the hospital events meeting. Thanks