Post Your Cases > Unsuccessful arousal from anesthesia after hours of accidentally high Lidocaine-Infusion
For a total of 5 hours surgery (lumbar spondylodesis) patient received lignocaine continous infusion as part of multimodal analgesia. Instead of correct dose of 1,33mg/kg/h (approx. 85mg/h), she received 85 ML / h of a 20mg/ml solution = 1700mg per hour for a total of about 7000mg. It was noted during turn over to other anesthetist at noon and immediately stopped. Surgery concluded unenventfully but patient did not wake up for about 1-2 hours. At this point everything else was ruled out (relaxation, opioids, anticholinergic syndrom, blood glucose etc.). Flumazenil was tried, Thiamin infusion, physiostigmine etc. She was mechanically ventilated and breathed spontanously, pupils were regular. No reaction to stimulus or suctioning. No arrhythmia at any given point, vasopressors were never used, vitals were always fine. BGA were always negative (no acidosis, no lactate etc.) Blood work (liver, kidney etc.) always fine.
After Infusion of 150ml Lipids 20% and 250ml twice for 20min, she woke up and recovered without any neurologic damages. A CAT scan was not deemed necessary. She was extubated in the afternoon. She was discharged from ICU the next morning. Following blood work was negative.
Instead of correct dose of 1,33mg/kg/h (approx. 85mg/h), she received 85 ML / h of a 20mg/ml solution = 1700mg per hour for a total of about 7000mg.
It was noted during turn over to other anesthetist at noon and immediately stopped. Surgery concluded unenventfully but patient did not wake up for about 1-2 hours.
At this point everything else was ruled out (relaxation, opioids, anticholinergic syndrom, blood glucose etc.). Flumazenil was tried, Thiamin infusion, physiostigmine etc.
She was mechanically ventilated and breathed spontanously, pupils were regular. No reaction to stimulus or suctioning.
No arrhythmia at any given point, vasopressors were never used, vitals were always fine.
BGA were always negative (no acidosis, no lactate etc.)
Blood work (liver, kidney etc.) always fine.
After Infusion of 150ml Lipids 20% and 250ml twice for 20min, she woke up and recovered without any neurologic damages. A CAT scan was not deemed necessary.
She was extubated in the afternoon.
She was discharged from ICU the next morning. Following blood work was negative.