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Anesth Analg 2008; 106:1575-1577
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e3181683dd7
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CASE REPORT

Reversal of Central Nervous System and Cardiac Toxicity After Local Anesthetic Intoxication by Lipid Emulsion Injection

Rainer J. Litz, MD, Thomas Roessel, MD, Axel R. Heller, MD, and Sebastian N. Stehr, MD

From the Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, University of Technology, Dresden, Germany.

Address correspondence and reprint requests to Dr. Rainer J. Litz, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, University of Technology, Fetscherstr. 74, 01307 Dresden, Germany. Address e-mail to rainer.litz{at}uniklinikum-dresden.de.

A 91-yr-old man (57 kg, 156 cm, ASA III) received an infraclavicular brachial plexus block for surgery of bursitis of the olecranon. Twenty minutes after infraclavicular injection of 30 mL of mepivacaine 1% (Scandicain®) and 5 min after supplementation of 10 mL of prilocaine 1% (Xylonest®) using an axillary approach, the patient complained of agitation and dizziness and became unresponsive to verbal commands. In addition, supraventricular extrasystole with bigeminy occurred. Local anesthetic toxicity was suspected and a dose of 200 mL of a 20% lipid emulsion was infused. Symptoms of central nervous system and cardiac toxicity disappeared within 5 and 15 min after the first lipid injection, respectively. Plasma concentrations of local anesthetics were determined before, 20, and 40 min after lipid infusion and were 4.08, 2.30, and 1.73 µg/mL for mepivacaine and 0.92, 0.35, and 0.24 µg/mL for prilocaine. These concentrations are below previously reported thresholds of toxicity above 5 µg/mL for both local anesthetics. Signs of toxicity resolved and the patient underwent the scheduled surgical procedure uneventfully under brachial plexus blockade.




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S. J. Brull
Lipid Emulsion for the Treatment of Local Anesthetic Toxicity: Patient Safety Implications
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Anesth. Analg., May 1, 2008; 106(5): 1340 - 1342.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2008 by the International Anesthesia Research Society.