Tachycardia and convulsions induced by accidental intravascular ropivacaine injection during sciatic block

Petitjeans, Fabrice; Mion, G.; Puidupin, M.; Tourtier, Jean Pierre; Hutson, Clare F.; Saissy, J. M.

doi:10.1034/j.1399-6576.2002.460524.x

Cited by 47 publications

(21 citation statements)

References 21 publications

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“…[1][2][3] However, it is a potent local anesthetic and ropivacaine-induced convulsions, cardiac dysrhythmias and even cardiac arrests have been described after unintentional intravascular injection during peripheral nerve blocks. [5][6][7][8][9][10][11][12] In a recent case report by Klein et al successful resuscitation after ropivacaine-induced ventricular fibrillation was described where resuscitation measures were successful without defibrillation. 13 Defibrillation was planned, but with the use of oxygen, propofol, intubation and chest compression, the circulation returned before the defibrillator was ready to use.…”

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confidence: 99%

Successful defibrillation immediately after the intravascular injection of ropivacaine

Gielen

Slappendel

Jack

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To report successful resuscitation of ventricular fibrillation induced by accidental intravascular injection of ropivacaine.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 15-yr-old healthy girl weighing 59 kg was scheduled for transposition of the tibial tuberosity under combined sciatic/three-in-one block. No premedication was given. In the induction room, an iv infusion was started, along with electrocardiogram monitoring, non-invasive blood-pressure measurement and pulse-oximetry. The sciatic nerve was found with the use of a nerve stimulator at the first attempt by the classical approach of Labat. Aspiration for blood was negative and the injection of ropivacaine 0.75% without epinephrine started. Convulsions, followed within seconds by ventricular fibrillation occurred at the end of the injection of 18 mL ropivacaine 0.75%. Oxygen was administered by face mask ventilation and immediate defibrillation was successful on the second attempt (2 × 200 joules). Within two minutes convulsions stopped and normal cardiac rhythm returned. Propofol and sufentanil were injected and a laryngeal mask inserted to start general anesthesia for surgery. Postoperatively no evidence of sciatic block could be demonstrated. The patient did not remember the event and was discharged the following day with no residual effects.

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confidence: 99%

Successful defibrillation immediately after the intravascular injection of ropivacaine

Gielen

Slappendel

Jack

2005

Can J Anesth/J Can Anesth

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“…Em diferentes estudos, concentrações plasmáticas elevadas de ropivacaína, após anestesias regionais (de 2 a 5,6 mg.l -1 ), foram alcança-das sem toxicidade neurológica e cardíaca 16,17 . Contudo, vários acidentes após a utilização da ropivacaína têm sido relatados [18][19][20][21][22][23][24][25] . Estes acidentes foram conseqüência de injeções intravasculares diretas (início rápido) ou secundárias à absorção plasmática por excesso de dose (evento clínico tardio).…”

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“…In different studies, high ropivacaine plasma concentrations after regional anesthesia (2 to 5.6 mg.L -1 ) were reached without neurological and cardiac toxicity 16,17 . However, several ropivacaine-related accidents have been reported [18][19][20][21][22][23][24][25] . These accidents were caused by direct intravascular injections (fast onset) or secondary to plasma absorption due to overdose (late clinical event).…”

Section: Discussionmentioning

confidence: 99%

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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“…[1][2][3][4][5] This possibility is of particular concern at the upper extremity since many of the nerve targets are located in highly vascular regions. Methods to minimize this risk include the use of slow incremental injection, the aspiration of syringes prior to injection of local anesthetic, and monitoring heart rate or T-wave amplitude changes following injection of a test dose of epinephrine.…”

Section: Résumémentioning

confidence: 99%

No change in impedance upon intravascular injection of D5W

Chin

Tsui

2010

Can J Anesth/J Can Anesth

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Purpose Electrical impedance increases following test injections of non-conducting solutions around nerves; however, this increase should diminish rapidly with intravascular needle placement, wherein the systemic circulation will dissipate the solution. For this observational study, we hypothesized that the impedance increases significantly at the perineural space after an injection of 5% dextrose in water (D5W), but that it does not increase correspondingly at the intravascular location Methods After Ethics Research Board approval, electrical impedance was measured by a nerve stimulator displaying resistance, StimuplexÒ HNS 12, before and during (30 sec) an injection of D5W 3 mL: 1) during intravenous cannula placement using an insulated stimulating needle sheathed in its plastic cannula, MultiSet NanoLine with 18G needle; and 2) during needle placement (Pajunk 22G insulated) for an ultrasound-guided supraclavicular block in patients undergoing hand surgery. The impedance changes at each location were analyzed and compared. Results Data were collected from 16 patients. Baseline impedance was lower intravascularly (mean 16.5 ± standard deviation 7.2 kX) compared with perineurally (23.5 ± 8.3 kX) (P = 0.037). Peak impedance after intravascular D5W injection was 20.1 ± 6.8 kX, which was not a significant change (P = 0.15). In contrast, peak impedance after perineural D5W injection was 58.6 ± 29.1 kX, an increase of 35.1 ± 26.4 kX (155 ± 117%), and then it reached a plateau of 36.7 ± 19.6 kX. The increase in impedance was significantly greater at the perineural location (P \ 0.0001). Conclusion The absence of a significant increase in impedance upon injection of D5W prior to injection of local anesthetic may provide useful information to warn of intravascular injection. RésuméObjectif L'impe´dance e´lectrique augmente apre`s les injections de test de solutions non conductrices autour des nerfs; toutefois, cette augmentation devrait diminuer rapidement lors d'un positionnement intravasculaire de l'aiguille, situation dans laquelle la circulation syste´mique dissipera la solution. Pour re´aliser cette e´tude observationnelle, nous avons e´mis l'hypothe`se que l'impe´dance augmentait de façon significative dans l'espace pe´rineural apre`s une injection de dextrose a`5 % dilue´e dans de l'eau (D5W), mais qu'elle n'augmentait pas de la meˆme manie`re dans un site intravasculaire. Méthode Apre`s avoir reçu l'approbation du Comited 'e´thique de la recherche, l'impe´dance e´lectrique a e´teḿ esure´e à l'aide d'un stimulateur nerveux affichant la re´sistance, le StimuplexÒ HNS 12, avant et pendant (30 sec) une injection de 3 mL de D5W: 1) pendant le positionnement d'une canule intraveineuse a`l'aide d'une aiguille de stimulation isole´e prote´ge´e par sa canule de plastique, le MultiSet NanoLine avec une aiguille 18G; et 2) pendant le positionnement de l'aiguille (Pajunk 22G isole´e) pour un bloc supraclaviculaire par e´choguidage chez des patients subissant une chirurgie de la main. Les changements d'impe´dance a`c...

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Tachycardia and convulsions induced by accidental intravascular ropivacaine injection during sciatic block

Cited by 47 publications

References 21 publications

Successful defibrillation immediately after the intravascular injection of ropivacaine

Successful defibrillation immediately after the intravascular injection of ropivacaine

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

No change in impedance upon intravascular injection of D5W

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