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 neurologic sequelae. 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 803284869 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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