RESUMEN
Local anesthetic intoxication is an uncommon complication of regional anesthesia. We report the case of a 4-month-old infant who presented with generalized tonic-clonic seizure complicated by cardiac arrest secondary to a severe intoxication to local anesthesia. These complications were observed after a bilateral dorsal penile nerve block with lidocaine for circumcision in a non-hospital setting. This report emphasizes the potential risk of local anesthetic systemic toxicity in such circumstances and describes its treatment.
Asunto(s)
Anestesia Local/efectos adversos , Anestésicos Locales/envenenamiento , Circuncisión Masculina , Epilepsia Tónico-Clónica/inducido químicamente , Paro Cardíaco/inducido químicamente , Lidocaína/envenenamiento , Bloqueo Nervioso/efectos adversos , Preescolar , Humanos , Masculino , Índice de Severidad de la EnfermedadAsunto(s)
Anestesia Local/métodos , Anestésicos Locales/uso terapéutico , Manejo del Dolor/métodos , Dolor/tratamiento farmacológico , Sínfisis Pubiana , Adulto , Amidas/administración & dosificación , Amidas/farmacocinética , Amidas/uso terapéutico , Anestésicos Locales/administración & dosificación , Anestésicos Locales/farmacocinética , Femenino , Humanos , Dolor/etiología , Periodo Posparto , Embarazo , Sínfisis Pubiana/diagnóstico por imagen , Ropivacaína , UltrasonografíaRESUMEN
BACKGROUND: To study the risks of haemodynamic instability, and the possible occurrence of spinal haematoma, meningitis and epidural abscess when epidural analgesia is performed for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: We retrospectively analyzed the data of 35 patients treated by HIPEC with oxaliplatin or cisplatin. An epidural catheter was inserted before induction of general anaesthesia. Postoperatively, a continuous epidural infusion of ropivacain, then a patient-controlled epidural analgesia were started. RESULTS: The epidural catheter was used peroperatively before HIPEC in 12 subjects (34%), and after HIPEC in 23 subjects (66%). The median dose of ropivacain given peroperatively in the epidural catheter was 40 mg (30-75). Norepinephrin was used in two subjects (6%) peroperatively (median infusion rate 0.325 µg/kg per minute [0.32-0.33]), and in four subjects (11%) in the postoperative 24 hours. No spinal haematoma, meningitis or epidural abscess were noted. Five subjects (14%) had a thrombopenia or a prothrombin time less than 60% before catheter removal. Two subjects (6%) had a leukopenia before catheter removal. No thrombopenia or blood coagulation disorders were recorded the day of catheter removal. CONCLUSION: In this series of 35 patients, the use of epidural analgesia for HIPEC does not seem to be associated with a worse risk of haemodynamic instability, spinal haematoma, meningitis or epidural abscess. HIPEC with platinum salt is not incompatible with the safety of epidural analgesia, with an optimized fluid management peroperatively and the following of perimedullary anesthesia practice guidelines.