47kg Indigenous male brought to Cath Lab for AICD insertion after runs of sustained VT. Pt received 25mcg Fentanyl and 1mg Midazolam IV prior to Lignocaine 1% 100mg (20mls) + Bupivacaine 0.5% 100mg (20mls) to R) subclavian aspect. Pt was unable to tolerate procedure so received a 2nd dose of Lignocaine 2% (checked with the surgeon prior), 200mg (10mls). Approximately 30 minutes into the procedure the pt became agitated and exhibited minor seizure like activity. Emergency button pressed. Anaesthetics attended. Lignocaine toxicity rescue box retrieved and initial 20ml bolus of intralipid given my Anaesthetist. 1.5mg of Midazolam also given with good effect. Pt was on pads and LifePak from the beginning of the procedure, no changes in cardiac rhythm were observed. Anaesthetist stayed for the rest of the procedure and bolused another 50mls Intralipid. Pt stabilised and did not require infusion. Remained in Cath Lab for recovery, (Cath Lab nurses in this facility are anaesthetic trained) until direct retrieval to CCU with Anaesthetic escort. Pt was drowsy but responding appropriately to voice and questions prior to his departure from the lab. Pt follow up today - nil issues reported by CCU. Pt is for discharge today. Riskman created. Further training for Cath Lab Nurses with regards to lignocaine toxicity. Intralipid Lipid Rescue guidelines reviewed. Chart created for pt weights for bolus and infusions. Additional chart created for maximum recommended doses for lignocaine and bupivicaine for pts by weight. Discussed at morning huddle today. To be discussed at the relevant care committees.
Riskman created. Further training for Cath Lab Nurses with regards to lignocaine toxicity. Intralipid Lipid Rescue guidelines reviewed. Chart created for pt weights for bolus and infusions. Additional chart created for maximum recommended doses for lignocaine and bupivicaine for pts by weight. Discussed at morning huddle today. To be discussed at the relevant care committees.