Bupivacaine
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Pulmonary embolism: case report A 48-year-old man developed pulmonary thromboembolism after treatment with combined spinal and epidural analgesia with bupivacaine before surgery. The man, who was a smoker, was scheduled for surgical fixation of a right femoral fracture. An epidural catheter was placed at L3-L4, fixed at 11cm [drugs not stated]. At the same level, a spinal needle was used to administer 15mg of 0.5% bupivacaine heavy to the subarachnoid space. About 35 minutes later, during surgery, he developed dyspnoea and chest pain. His oxygen saturation fell, and he became tachypnoeic with coughing. A mask was used to deliver oxygen, but he had further coughing; pulmonary embolism was suspected. Dopamine was initiated; reduced breath sounds on his right side were noted. The man was anaesthetised and intubated. Chest x-ray revealed right-sided pneumothorax, and an intercostal drain was placed. The surgery was completed, and he was moved to an ICU with mechanical ventilation. D-dimer was found to be elevated, and Doppler scan revealed deep vein thrombosis of his right leg. He received enoxaparin and epidural bupivacaine. He was extubated after 3 days, and discharged home on day 15. Author comment: "Chronic smokers are at a higher risk of developing deep vein thrombosis, which can lead to [pulmonary thromboembolism] following venodilation due to spinal anesthesia." Bansal S, et al. Pneumothorax complicating pulmonary embolism after combined spinal epidural anesthesia in a chronic smoker with open femur fracture. Journal of Anaesthesiology Clinical Pharmacology 27: 403-405, No. 3, Jul-Sep 2011. Available from: URL: http://dx.doi.org/10.4103/0970-9185.83695 803061306 India
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Reactions 15 Oct 2011 No. 1373
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