Ropivacaine-induced seizure after extradural anaesthesia

Abouleish, Ezzat; Elias, Mazin; Nelson, Cindy

doi:10.1093/bja/80.6.843

Cited by 58 publications

(28 citation statements)

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“…Although cardiopulmonary resuscitation was favored by early treatment, intrinsic ropivacaine low toxicity (as compared to bupivacaine) might have determined the outcome. In contrast with the difficult reverting cardiac arrests due to bupivacaine intoxication, where even cardiopulmonary bypass has been used 33,34 , our case's successful treatment -not exceeding one minute -has allowed the surgery to be performed, in line with previous publications 7, 35 . Case 1 patient was in irregular use of b-blockers.…”

Section: Discussionsupporting

confidence: 84%

“…Embora a reanimação cardiopulmonar tenha sido facilitada pelo tratamento precoce, a baixa cardiotoxicidade intrínseca da ropivacaína (quando comparada à da bupivacaí-na) pode ter sido determinante no resultado. Além disso, o bem sucedido tratamento, que não excedeu um minuto, contrasta com a dificuldade em se reverter quadros de parada cardíaca devidos à intoxicação pela bupivacaína, para os quais se utilizaram até circulação extracorpórea 33,34 , possibilitando que a cirurgia fosse realizada, em concordância com publicações anteriores 7,35 . Somente a paciente do caso 1 fazia uso, irregularmente, de b-bloqueador.…”

Section: Discussionunclassified

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Injeção intravascular acidental de ropivacaína a 0,5% durante a realização de anestesia peridural torácica: relato de casos

Curtis¹,

Furlani²,

Castiglia³

2004

Rev. Bras. Anestesiol.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionunclassified

Injeção intravascular acidental de ropivacaína a 0,5% durante a realização de anestesia peridural torácica: relato de casos

Curtis¹,

Furlani²,

Castiglia³

2004

Rev. Bras. Anestesiol.

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“…However, in this study no direct comparisons with ropivacaine or S(¹) bupivacaine were made, nor are there any reports in humans of this interesting effect. Irrespective of the wider safety margin compared with other local anaesthetics, there are reports 1999, 54, pages 1178-1182 ........................................................................................................................................................................................................................................... of toxic reactions with ropivacaine and care must still be taken with the administration of any highly concentrated local anaesthetic [18,19]. Minor morbidity is rarely reported in studies of local anaesthetics for ophthalmic anaesthesia, so comparisons with our data are not possible.…”

Section: Discussionmentioning

confidence: 99%

A comparison of 1% ropivacaine with a mixture of 0.75% bupivacaine and 2% lignocaine for peribulbar anaesthesia

McLure¹,

Rubin²,

Westcott

et al. 1999

Anaesthesia

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SummaryIn a single centre, randomised, double-blind study, 54 patients underwent intraocular surgery under peribulbar anaesthesia with either ropivacaine 1% or a mixture of bupivacaine 0.75% and lignocaine 2%, both with hyaluronidase 7.5 iu.ml ¹1 . There were no significant differences in volume of anaesthetic required, time to onset of block, peri-operative pain scores or frequency of adverse events between the ropivacaine group and the lignocaine and bupivacaine group.

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“…Although ropivacaine has been reported to have less cardiotoxicity than bupivacaine, cardiovascular complications may still occur after inadvertent intravenous administration or following absorption. 1,2 There has been much interest in the untoward cardiovascular effects of potent long acting anesthetics. [3][4][5][6] However, few detailed studies have determined whether animals could be successfully resuscitated.…”

Section: Resultsmentioning

confidence: 99%

Milrinone is superior to epinephrine as treatment of myocardial depression due to ropivacaine in pigs

Neustein

Sampson

Dimich

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To determine whether milrinone is more effective than epinephrine in the resuscitation of ropivacaine induced cardiotoxicity in pigs.Methods: Arterial, pulmonary, and LVdP/dt catheters were placed in 12 anesthetized, intubated and mechanically ventilated pigs. They received ropivacaine iv to cardiovascular toxicity: 50% decrease in LVdP/dt, cardiac output and mean arterial pressure (MAP). Group I (n=6) was treated with 100 µg·kg -1 milrinone iv, and Group II (n=6) received 0.5 mg epinephrine iv. Resuscitation was successful if cardiac output returned to baseline, and MAP reached 80% of baseline.Results: After ropivacaine, MAP decreased from 88 ± 7 to 49 ± 8 mmHg (P < 0.05), CO decreased from 2.8 ± 0.4 to 1.2 ± 0.2 L·min -1 (P < .05), HR decreased from 103 ± 8 to 74 ± 7 beats·min (P < 0.05) and LVdp/dt decreased from 1950 ± 130 to 755 ± 125 mmHg (P < 0.05). The LV EDP increased from 5 ± 1 to 8 ± 1 mmHg (P < 0.05) and SVR from 2317 to 3000 ± 120 dynes·sec. Electrocardiogram changes included increases in the QTU interval and QRS duration. In all animals, milrinone restored MAP, CO, SV, HR, and dP/dt to baseline and no animal developed arrhythmias. In contrast, epinephrine produced severe hypertension and tachycardia. There was no improvement in CO or SV, and SVR increased. Epinephrine caused A-V dissociation and ventricular arrhythmias in three animals. Conclusion:Milrinone, was more successful than epinephrine in resuscitating anesthetized pigs from ropivacaine-induced cardiovascular toxicity.Objectif: Déterminer si la milrinone est plus efficace que l'épinéphrine au moment de réanimer des porcs victimes d'une cardiotoxicité induite par la ropivacaïne.Méthode : Des cathéters artériels, pulmonaires et ventriculaires gauches (dP/dtVG) ont été mis en place chez 12 porcs anesthésiés, intubés et sous ventilation mécanique. Ils ont reçu de la ropivacaïne iv qui a provoqué la cardiotoxicité manifestée par : une baisse de 50 % dP/dtVG, du débit cardiaque (DC) et de la pression artérielle moyenne (PAM). Le groupe I (n=6) a été traité avec 100µg·kg Résultats : Après l'administration de la ropivacaïne, la PAM a chuté de 88 ± 7 à 49 ± 8 mmHg (P < 0,05), le DC de 2,8 ± 0,4 à 1,2 ± 0,2 L·min -1 (P < 0,05), la FC de 103 ± 8 to 74 ± 7 battements·min (P < 0,05) et dP/dtVG de 1950 ± 130 à 755 ± 125 mmHg (P < 0,05). La pression télédiastolique du VG a augmenté, passant de 5 ± 1 à 8 ± 1 mmHg (P < 0,05) et la résistance vasculaire périphérique (RVP) de 2317 à 3000 ± 120 dynes·s . Les changements à l'électrocardiogramme comprenaient des augmentations de l'intervalle QTU et de la durée de QRS. Chez tous les animaux, la milrinone a ramené la PAM, le DC, le débit systolique (DS), la FC et dP/dt aux valeurs de base et aucun animal n'a présenté d'arythmie. Par ailleurs, l'épinéphrine a produit une sévère hypertension et de la tachycardie. Il n'y a pas eu d'amélioration du DC ou du DS et la RVP a augmenté. L'épinéphrine a aussi causé une dissociation AV et des arythmies ventriculaires chez trois animaux.Conclusion : La milrinone a é...

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Ropivacaine-induced seizure after extradural anaesthesia

Cited by 58 publications

References 9 publications

Injeção intravascular acidental de ropivacaína a 0,5% durante a realização de anestesia peridural torácica: relato de casos

Injeção intravascular acidental de ropivacaína a 0,5% durante a realização de anestesia peridural torácica: relato de casos

A comparison of 1% ropivacaine with a mixture of 0.75% bupivacaine and 2% lignocaine for peribulbar anaesthesia

Milrinone is superior to epinephrine as treatment of myocardial depression due to ropivacaine in pigs

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