Post Your Cases > LAST in 72 yo after thoracic paravertebral

72 year old with OSA HTN DM CKD presented for lumpectomy. 0.75% bupivacaine used as local - planned to perform 10 cc injection at T2 and T4. This was performed at a teaching institution and several attempts were made to find paravertebral space with predetermined distance technique (5 cc was injected subcutaneously). After space was identified, 10 cc was injected into paravertebral space. Patient immediately became unresponsive. Patient was laid down on bed supine and started showing seizure like activity. Midazolam given, called for help and intralipid STAT. Midazolam given and seizure activity stopped. Intralipid bolus of 100 cc given within 2 minutes of patient becoming unresponsive. Infusion continued and ventilation supported with bag mask ventilation. Patient unresponsive for another 5 minutes. Bag mask ventilation continued and ventilator called for by bedisde in anticipation of intubation. Within 10 minutes, patient all of a sudden opened her eyes and started supporting her own ventilation and answering questions. She received a total of 300 cc of intralipid and was hemodynamically stable throughout episode. Patient remained neurovascularly intact for another 3 hours. Decision made to proceed with surgery. Patient had lumpectomy without any complications and stated that she had no pain post-operatively.
September 10, 2019 | Unregistered CommenterK Bland