Post Your Cases > MD

We had a case of a 21 year old patient who underwent an axillary nerve block for ORIF of the hand. Pt experienced very acute onset of confusion and slurring of speech. Heart rate increased (from a baseline rate of 65) to 130 with frequent PVCs. Shortly after onset of confusion, twitching movement was noted in upper extremities. 20% intralipid infusion was immediately initiated. 1 minute into infusion, speech cleared. 3 minutes into infusion, twitching stopped. 12 lead EKG obtained showing sinus tach. Within 6 minutes of initiation of intralipid, heart rate decreased to baseline of 65 and PVCs disapeared.

This seems like a fairly significant case of local anesthetic toxicity with rapid response to intralipid. Thoughts?
February 26, 2009 | Unregistered CommenterMaureen Leist, MD
Another great case. If there continues to be slow uptake of the notion that intralipid is a treatment for LA toxicity, it would seem appropriate to combine these relatively benign cases of CNS/mild CV symptoms that are cleared by intralipids. Perhaps a series of case reports is indicated?
February 27, 2009 | Unregistered Commentermmanley
What can I say, but 'Right on!'. I agree that based on the rapidity of onset and progression to PVCs this was a potentially severe toxic reaction that your treatment attenuated, possibly averting a real catastrophe. In that sense it is reminiscent of the report by McKutcheon and another by Spence in a parturient (see link to case reports) and others where early intervention appears to be potentially very beneficial.
Nice job. And just think: no horrific, sad talks with the family, no depositions to give, no lawyers or insurance companies to talk to. AND think of what you've saved the family from.
Final point a propos dr manleys' comment. I believe there will be a series of cases published soon as letters to the editor...stay posted.
Congrats
guy
February 27, 2009 | Registered Commenter[Guy Weinberg]