Identifying info removed: Small framed 60 kg lady presented for knee surgery requiring AC and iPACK blocks. AC block completed under ultrasound guidance, 20 cc 0.35% Ropivacaine followed by iPACK block with 20 cc 0.35% Ropivacaine also under U/S guidance. Local anesthetic deposited in both locations after verifying negative aspiration every 2-5cc of local anesthetic injection. About 1minute after the iPACK block and during block documentation, patient had a tonic clinic seizure, we called for help, started intralipid and attended to patients airway, 40cc of intralipid was bolused and bag kept wide opened under pressure bag. Patient was bagged while intralipid was initially administered, copious secretions was suctioned out which initially obscured our view of the airway during DL. A brief period of pulselessness (1-2 min) responded promptly to cpr and epinephrine administration, Case was cancelled. Patient came to full consciousness approximately 30 minutes after initial event and was extubated and recovered in ICU.
Small framed 60 kg lady presented for knee surgery requiring AC and iPACK blocks. AC block completed under ultrasound guidance, 20 cc 0.35% Ropivacaine followed by iPACK block with 20 cc 0.35% Ropivacaine also under U/S guidance. Local anesthetic deposited in both locations after verifying negative aspiration every 2-5cc of local anesthetic injection. About 1minute after the iPACK block and during block documentation, patient had a tonic clinic seizure, we called for help, started intralipid and attended to patients airway, 40cc of intralipid was bolused and bag kept wide opened under pressure bag. Patient was bagged while intralipid was initially administered, copious secretions was suctioned out which initially obscured our view of the airway during DL. A brief period of pulselessness (1-2 min) responded promptly to cpr and epinephrine administration, Case was cancelled. Patient came to full consciousness approximately 30 minutes after initial event and was extubated and recovered in ICU.