Reactions 1680, p303 - 2 Dec 2017
Acute brainstem dysfunction secondary to total
spinal and brainstem anesthesia: case report
A 51-year-old woman developed acute brainstem
dysfunction secondary to total spinal and brain stem
anaesthesia, after receiving paravertebral administration of
0.2% ropivacaine 120mg for six hours.
The woman had severe chronic obstructive pulmonary
disease, and underwent lung transplantation for the same.
After the surgery, she received ropivacaine infusion through a
T7-T8 paravetebral catheter as postoperative analgesia. She
developed quadriparesis after a while [duration of treatment to
reaction onset not clearly stated]. Around 5.5 hours after the
administration, her pupils in both eyes became fixed and
dilated. Her tone became flaccid. Her deep tendon reflexes
were missing, while her toes were unresponsive to any
stimulation. An absence of horizontal eye movements was
observed in an oculocephalic maneuver.
The woman’s treatment with ropivacaine was stopped. Her
systolic B.P was above 90mm Hg while on norepinephrine.
She became conscious after elevating the head of bed. She
regained strength in her arms, and an hour later she was able
to move her legs. Her pupils became normal with full
extraocular movements, but her bilateral end-gaze nystagmus
was present for several hours. An MRI scan showed a
collection of fluid in the epidural region. She was extubated on
the next day. She complained of headache and nausea, which
improved after lying flat and administration of caffeine and
analgesics. She went home after ten days without any
Author comment: "We report a case of total spinal and
brain-stem anaesthesia, defined as anaesthetic block of the
cervical cord and brainstem or cranial nerves, following
paravertebral ropivacaine anaesthesia."
Foster LA, et al. Total spinal and brainstem anesthesia as complication of
paravertebral ropivacaine administration. Neurology: Clinical Practice 7: 430-432,
No. 5, Oct 2017. Available from: URL: http://doi.org/10.1212/
CPJ.0000000000000355 - USA
Reactions 2 Dec 2017 No. 16800114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved