LipidRescue™ Resuscitation

21yo female, 76kg, for bilateral breast reduction planned pre-op T-4 ESPB using 133mg exparel and 50mg bupivacaine diluted to 30ml per side. After maintaining verbal contact throughout, one minute after needle removed on second side, while still in sitting position, seizure activity started. supportive care provided an placed in left semi-Fowlers and intralipid started for bolus of 100ml in three min. after approx. 50ml sz activity stopped, airway secured and transported to ICU. pt recovered with no other cardiac involvement other than the sinus tach seen with sz. Pt extubated within one hour after 20min infusion complete and discharged the next day. All aspirations every 5ml were negative and the needle was visualized with U/S throughout.