Bupivacaine
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Nausea, transient equine tail syndrome and bradycardia: 3 case reports In a retrospective and observational study of 69 patients undergoing muscle biopsy for in-vitro muscle contracture test between 2004 to 2010, three adult patients [exact ages at the time of reactions onsets not stated] were described, who developed nausea, transient equine tail syndrome or bradycardia during treatment with lidocaine and epinephrine for peripheral nerve block and bupivacaine for spinal anaesthesia [times to reactions onsets not stated; not all routes and outcomes stated]. All the patients had a suspicion of malignant hyperthermia (MH) and were undergoing muscle biopsy for in-vitro muscle contracture test. All the patients received pre-anaesthetic medication of midazolam. Later, they underwent peripheral nerve block with lidocaine 1.5% in epinephrine [adrenaline] 1:200 000. However, due to peripheral nerve block failure, they received 0.5% hyperbaric bupivacaine for spinal anaesthesia. Subequently, the patients developed anaesthesiarelated adverse effects including nausea, transient equine tail syndrome and bradycardia (1 patient each). All the patients remained in the post-anaesthesia care unit for minimum of 6 h postoperatively. Malignant hyperthermia was excluded on the basis of muscle biopsy findings. Author comment: However, six patients (8.7%) had other anaesthesia-related adverse effects for muscle biopsy, such as nausea (n=4; 5.8%), transient neurologic syndrome (n=1; 1.4%), and bradycardia (n=1; 1.4%), all of which occurred in patients undergoing spinal anaesthesia. Note that three patients who received spinal anaesthesia had unsuccessfully received peripheral nerve block. Silva HCAD, et al. Anesthesia for muscle biopsy to test susceptibility to malignant hyperthermia. Revista Brasileira de Anestesiologia 69: 335-341, No. 4, Jul-Aug 2019. Available from: URL: http://doi.org/10.1016/j.bjan.2019.02.001 [Portuguese; 803432795 summarised from a translation] - Brazil
0114-9954/19/1778-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 9 Nov 2019 No. 1778
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