Years ago, I did a Femoral nerve block with continuous catheter (US Guided) and used 0.5% ropivacaine (5ml) + 2% lidocaine (10 ml) for the initial block. Pt had LMA, underwent longer than expected knee surgery (ACL reconstruction, etc), and I bolused another ropivacaine 0.5% 5ml about 2 1/2 hours into the surgery. Everything was good. I left for a break, CRNA took over, case was finishing and although I had told the surgeon (and documented) multiple times that only use morphine and toradol intra-articular, he wasn't thinking, I wasn't there, long story short, surgeon gave 30 ml of bupivacaine 0.5% along with astramorph and toradol.
When I returned I noticed some EKG changes, and asked what happened while gone, and I was told, the surgeon then said "Sh.....t" and I left him on LMA and we watched for awhile and tried to awaken him, he was originally groggy and then became very agitated, I gave some versed/ativan, and called for intralipids, the hospital pharmacist that knew where to get them was at lunch. After multiple persistant and worsening EKG changes, I passed a small ETT through the LMA and "intubated" verified BS b/l, and his BP originally went up with the agitation and then started to drop and go into multiple arrythmias- heart blocks - I then decided to create some pressors with phenylephrine, epi, and ephedrine, and dobutamine, and hung them, enterred into pump system.
Afterward, I started giving him large doses of propofol thinking that the emulsion in it may help to do the same thing as intralipid, and I ran "alot" of propofol into this 17 yo kid, and used pressors when needed,
I continued the game for hours, and then seemed to stabilize on EKG and kept in PACU for total 10 hours and d/c'd home.

SO the question is: Did the propofol work like the intralipids, or was I just playing cocktail waitress with pushing drugs all over the place.

I told family what happened after the surgeon and I got our stories straight. We ran a EEG in the PACU and multiple EKG's, and neuro consult and overall, he was a healthy 17 yo soccer player and went home and "no big deal" but I have always wondered If I actually did anything or just time and youth cleared the problem.

I would love some input, good, bad, ugly.
Thanks