Local anaesthetic systemic toxicity complicating intraoperative intercostal nerve blocks: What do clinicians need to know to prevent similar occurrence?

Local anaesthetic systemic toxicity is a life-threatening adverse event that may occur after administration of local anaesthetics through a variety of routes. Local anaesthetic systemic toxicity is always a potential complication and may occur with all local anaesthetics and in any route of administration. Local anaesthetic systemic toxicity primarily affects the central nervous system and the cardiovascular system and may be fatal. The following is a case of local anaesthetic systemic toxicity complicating surgeon-performed intraoperative intercostal nerve blocks at multiple levels, with a mixture of liposomal bupivacaine and bupivacaine hydrochloride in a patient who underwent video-assisted segmental lung resection for lung cancer under general anaesthesia. Local anaesthetic systemic toxicity presented with seizures and hypotension. The patient was successfully managed and fully recovered. This case illustrates the importance of awareness regarding the prevention, diagnosis and treatment of local anaesthetic systemic toxicity among medical professionals who administer local anaesthetics.

Postoperative Serotonin Syndrome Following Methylene Blue Administration for Vasoplegia After Cardiac Surgery: A Case Report and Review of the Literature.

Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. The increasing incidence of this condition is thought to parallel the increasing use of serotonergic agents in medical practice. The selective serotonin reuptake inhibitors are perhaps the most commonly implicated group of medications associated with serotonin syndrome. This case report describes the occurrence of postoperative serotonin syndrome in a patient on long-term sertraline who underwent coronary artery bypass graft and was treated with methylene blue for perioperative vasoplegia. It delineates the various clinical features commonly encountered and illustrates the recommended management modalities, including prevention, for this potentially lethal medical emergency. With prompt diagnosis and expeditious treatment, the patient has had full recovery.

Iatrogenic intramural hematoma of the ascending aorta complicating inadvertent arterial cannulation during central venous catheter placement. A case report and review of the literature.

Aortic injury during central venous catheter (CVC) insertion is a rare but serious complication. This presentation describes a case of iatrogenic intramural hematoma of the ascending aorta complicating inadvertent arterial cannulation of the right subclavian artery during attempted Port-A-Cath insertion at the right subclavian vein. Various strategies for the prevention and management of aortic injury during CVC placement are discussed. In this case, the hematoma was managed surgically and replacement of the ascending aorta was undertaken under deep hypothermic circulatory arrest.

AngioVac Suction Thrombectomy Complicated by Thrombus Fragmentation and Distal Embolization Leading to Hemodynamic Collapse: A Case Report.

A 35-year-old morbidly obese woman with a history of deep vein thrombosis and pulmonary embolism presented for right atrial thrombectomy via AngioVac suction system. A portion of the thrombus could not be suctioned into the AngioVac cannula, leading to fragmentation and distal embolization with hemodynamic collapse. This sequence, observed in real time under transesophageal echocardiography, also demonstrated that the clot had echocardiographic features of chronicity. A well-organized chronic clot may be more difficult to extract via this method, leading to the complication described. With increasing popularity of this less invasive method, further investigation to understand the indications and contraindications is warranted.