Bupivacaine
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Loss of consciousness and apnoea: case report A 31-year-old woman developed loss of consciousness (LOC) and apnoea following treatment with bupivacaine for spinal anaesthesia during delivery. The pregnant woman, who had a history of caesarean sections (CS) during previous pregnancies, was admitted to the hospital in Turkey for an emergency CS. She had no complications under general anaesthesia during the previous CS. Her preoperative laboratory work-up was found to be normal. She received 1000mL of 0.9% IV sodium chloride solution as a premedication. Thereafter, a slow intrathecal infusion of 1.9mL hyperbaric bupivacaine (0.5%) was given at the L3–4 in the sitting position under aseptic conditions. For the prevention of uterine compression, she was brought to the supine position immediately with a mild left lateral position and supplemental oxygen was given. Within 3 minutes of intrathecal injection, she achieved sensory block level at T4. In the first 10 min, her BP dropped (hypotension), which was normalised after administration of a single dose of ephedrine 10mg. In the 10th minute of anaesthesia, the woman delivered a baby. After the delivery, no medication was given except oxytocin. However, she developed sudden LOC starting at 10 min of anaesthesia. She did not respond to painful and verbal stimuli and had apnoea (breathing stopped). Her pupil was found to be normal with positive pupillary light reflex. Her vital signs were noted to be stable. She was immediately supported by balloon mask ventilation. Due to the duration of the apnoea period could not be estimated, she was not intubated. Five minutes later, she became conscious, cooperative, oriented and started breathing spontaneously with no elevation in sensory and motor block levels. About 5 minutes later, a new apnoea and LOC episode occurred, and the second LOC episode was lasted for about 5 minutes. After a consecutive period of 5 minutes, she developed the third episode of LOC with a rapid and shallow breathing but did not stop completely. Her last LOC episode lasted about 3 minutes. During the last two episodes, her BP and HR were found to be normal. She remained stable until the end of the CS without any complications. The analysis of blood samples drawn during the period of apnoea was unremarkable. After 4h of intrathecal injection, her Modified Bromage score was found to be 0. She could not remember about the LOC. No pathological findings were observed on post-operative cranial CT scan. After 2 days, she was discharged home without any complications. Kayaalti S. [Intermittent loss of consciousness during cesarean section under spinal anesthesia: a case report]. [Portuguese]. Revista Brasileira de Anestesiologia 69: 631-634, 803497887 No. 6, Nov-Dec 2019. Available from: URL: http://doi.org/10.1016/j.bjan.2019.09.006 [Portuguese; summarised from a translation]
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Reactions 22 Aug 2020 No. 1818
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