Post Your Cases > LAST during intravenous regional anesthesia
34 year old male, osteosynthesis implant removal after radius fracture. Intravenous regional anesthesia performed by trauma surgeon as an anesthesiologist was not available.
After exsanguinating the arm with an elastic bandage and inflating the pneumatic tourniquet 40ml of ropivacaine 0,75% were injected into the limb. Shortly thereafter, the patient reported a metallic taste and started to deteriorate. As the patient was unresponsive and agitated the decision was made to cancel surgery and deflate the tourniquet. Promptly, tonic-clonic convulsions started whereas cardiac arrhythmia did not occur.
The attending anesthesiologist was alerted and intiated lipid rescue protocol immediately. A bolus of 1,5ml 20% lipid emulsion / kg BW was administered over 1 minute followed by continuous infusion of 0,25ml / kg BW lipids for 30 minutes. A total dose of 20mg midazolame was required for seizure suppression. The patient was then transferred to the recovery room where he regained consiousness in the course of an hour. Overnight observation on intermediate care was uneventful.
After exsanguinating the arm with an elastic bandage and inflating the pneumatic tourniquet 40ml of ropivacaine 0,75% were injected into the limb. Shortly thereafter, the patient reported a metallic taste and started to deteriorate. As the patient was unresponsive and agitated the decision was made to cancel surgery and deflate the tourniquet. Promptly, tonic-clonic convulsions started whereas cardiac arrhythmia did not occur.
The attending anesthesiologist was alerted and intiated lipid rescue protocol immediately. A bolus of 1,5ml 20% lipid emulsion / kg BW was administered over 1 minute followed by continuous infusion of 0,25ml / kg BW lipids for 30 minutes. A total dose of 20mg midazolame was required for seizure suppression. The patient was then transferred to the recovery room where he regained consiousness in the course of an hour. Overnight observation on intermediate care was uneventful.