At an OP appt, pt had b/l occipital nerve blocks done with solumedrol and bupivacaine. The pt tolerated the L side with no event. When the Rt was done developed sudden agitation, vocal hoarseness, b/l non reactive dilated pupils, and nystagmus. She also was tachycardic and SBP increased to 170s briefly. Pt c/o feeling like throat was closing and then became unresponsive, hypoxic to 60s and hypotensive. Awake and alert on arrival to ED, but hypotensive requiring vasopressors. The pt admitted to ICU and subsequently the next day after echo showed profound drop in EF and regional wall abnormalities intralipid was started. Improvement with intralipid initially however the pt started to require levo again however she does have a history of POTs and hypotension at baseline requiring midodrine.
Does anyone have experience with intralipid treatment around 24 hours later?
Does anyone have experience with intralipid treatment around 24 hours later?