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Various toxicities: 2 case reports A prospective study of 1673 patients undergoing lower abdominal, perineal or lower limb surgeries at an institution in India between December 2009 and November 2010, described two patients including one woman [not all sexes stated; ages at the time of reactions onsets not stated], of whom, one patient developed breathlessness and inability to cough secondary to bupivacaine for spinal anaesthesia, whereas the other patient developed bradycardia and hypotension during treatment with bupivacaine, and exhibited treatment failure while being treated with atropine and glycopyrrolate for bradycardia [dosages not stated; not all routes, outcomes and times to reactions onsets stated]. A woman was scheduled for vaginal hysterectomy. She was preloaded with Ringer’s-lactate solution. Under aseptic condition, subarachnoid block was performed with intra-spinal injection of bupivacaine after local skin infiltration. After the first injection, she had a partial failure of the spinal anaesthesia; hence, the second injection was given. Five minutes after the second injection, she showed high spinal because the surgeon placed a small sandbag under her buttocks and she started complaining of breathlessness and inability to cough. The sensory level was at T2. Mean arterial pressure and heart rate started falling. The woman’s airway was secured with endotracheal tube and ventilated with nitrous-oxide/oxygen (N2O:O2) in the ratio 70:30. Unspecified crystalloid fluids were infused rapidly. Mephentaramine and dopamine were given. After 30 minutes, she became stable and surgery was allowed to proceed. The patient was scheduled for surgery and preloaded with Ringer’s-lactate solution. Under aseptic condition, subarachnoid block was performed with intra-spinal injection of bupivacaine after local skin infiltration. The patient developed severe bradycardia and hypotension during surgery. Heart rate came down to 32 and mean arterial pressure to 51mm Hg. The sensory level was at T4. The patient was treated with repeated doses of atropine and glycopyrrolate, which failed to increase the heart rate. The heart rate came up with infusion of isoprenaline. Unspecified crystalloid fluids and mephentaramine were given for hypotension. The patient was also taking unspecified beta blockers. Abraham AA, et al. Failed spinal anaesthesia- management by giving a second spinal. Sri Lankan Journal of Anaesthesiology 21: 14-19, No. 1, 22 Feb 2013. Available from: 803515547 URL: http://doi.org/10.4038/slja.v21i1.4327

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Reactions 21 Nov 2020 No. 1831