Bupivacaine
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Bupivacaine Various toxicities following drug exposure during pregnancy : case report
A 35-year-old woman developed apnoea, hypotension, bradycardia, hypoxia, difficulty breathing, apprehension, loss of consciousness, pulmonary oedema, hypoglycaemia and non-purposeful right-hand movement following administration of bupivacaine for spinal ansesthesia during pregnancy. The woman presented to the hospital in labor. Upon further investigation, an urgent cesarean section was planned due to cephalopulvic disproportion. She had a history of six vaginal delivery. She also had pregnancy-related hypertension. Spinal anaesthesia was also planned for the cesarean section. Therefore, She was pre-medicated with cimetidine 300mg and IV metoclopramide 10mg and infusion of sodium-chloride [normal saline] 500 mL solution during the pregnancy. Subsequently, she underwent spinal anaesthesia with 3mL of isobaric bupivacaine 0.5% [route not stated] after confirmation of free flow of cerebrospinal fluid. Bupivacaine was slowly injected, and she was placed in a supine position. Her BP was in normal range. Subsequently, she delivered a baby 16 minutes after the anaesthesia. After the delivery, she developed chest heaviness, difficulty breathing and apprehension. Therefore, 100% oxygen supply was provided and the woman’s vital sign measurement showed no significant disturbance. But, she developed apnoea and became unresponsive. Further examination showed hypotension with BP 80/34, bradycardia with heart rate 46 and hypoxia with SPO2 76. She failed to respond to the oxygen supplementation. Hence, she was treated with thiopentalsodium [thiopental] and orotracheal intubation. However, her hemodynamic condition remained unstable. Thus, repeated injections of epinephrine [adrenaline] and intra-operative volume replacement therapy was given. Subsequently, resuscitation was performed for 10–15 minutes and her vital signs improved. Spontaneous breathing effort resumed. Eventually, her haemodynamics had stabilised and the vasoactive medications were slowly withdrawn. But, she developed unresponsiveness. Thus, an artificial assisted ventilation and pressure support till the end of the procedure was provided. However, she developed pulmonary oedema and hypoglycemia that were manged with mechanical ventilation and administration of furosemide and glucose. But, she remained unresponsive with involuntary right-hand movement. Subsequently, mechanical ventilation was provided for 24 hours in the ICU and then she was extubated. Over the following week, she recovered and gradually regained sensory and motor functions and subsequently discharged from hospital with no sings of sequelae. It was concluded that her apnoea, hypotension, bradycardia, hypoxia, difficulty breathing, apprehension, loss of consciousness, pulmonary oedema, hypoglycaemia and non-purposeful righthand movement were secondary to bupivacaine administration for spinal anaesthesia [duration of treatment to reaction onset not stated]. Asfaw G, et al. A case of total spinal anesthesia. Int
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