tailieunhanh - Case report: intravenous lipid emulsion for treatment of local anesthetic toxicity following brachial plexus anesthesia

Local anesthetic system toxicity following brachial plexus anesthesia is severe complication of regional block. We reported a case of central nervous system toxicity following brachial plexus anesthesia, who was rescued successfully with intravenous lipid emulsion. | JOURNAL OF MILITARY PHARMACO-MEDICINE N07-2016 CASE REPORT: INTRAVENOUS LIPID EMULSION FOR TREATMENT OF LOCAL ANESTHETIC TOXICITY FOLLOWING BRACHIAL PLEXUS ANESTHESIA Vo Van Hien*; Nguyen Trung Kien* SUMMARY Local anesthetic system toxicity following brachial plexus anesthesia is severe complication of regional block. We reported a case of central nervous system toxicity following brachial plexus anesthesia, who was rescued successfully with intravenous lipid emulsion. * Key words: Local anesthetic system toxicity; Lipid emulsion. INTRODUCTION Local anesthetic system toxicity (LAST) is a recognized complication of major conduction anesthesia. The estimate of clinically important local anesthetic toxicity is from to 20 occurrences per 10,000 peripheral nerve blocks [6]. The incidence of toxicity is greater with brachial plexus techniques than most others, because larger than usual doses of local anesthetics are used and the injections are made in and around large vascular channels in the head, neck and axillary regions. LAST includes two major types: central nervous system toxicity and cardiovascular system toxicity that can be treated with lipid emulsion [1]. CASE REPORT A 73 years old man, 164 cm tall, 50 kg of weight, was admitted with right hand injury due to labour accident which required an emergency for wound resection and reformed index and middle finger amputation under supraclavicular approach anesthesia on Monday 27 of June, 2016. - Biochemical test: glucose mmol/L, ure mmol/L, creatinine 76 µmol/L, GOT 122 U/L, GPT 117 U/L, K+ mmol/L, Na+ 136 mmol/L; ECG was normal at rate of 67/min, sinus rythm. - Blood test: red blood cell Tera/L, hemoglobin 101 g/L, hematocrit l/L, platelet 100 G/L. - Continuously monitored of ECG, heart rate, oxygen saturation (SpO2). Blood pressure was monitored in mins interval; oxygen was given via facemask at a rate of 3 L/min. Blood pressure was 132/73 mmHg; respiratory rate 18 per minute. - In .