Status epilepticus induced by intrathecal bupivacaine use: A case report

Yıl 2014, Cilt: 5 Sayı: 1, 108 - 111, 01.03.2014

Eşref Akıl Sefer Varol Abdulmenaf Guzel Cuneyt Gocmez

https://doi.org/10.5799/ahinjs.01.2014.01.0371

Öz

Local anesthetics are commonly used as analgesics and anesthetics. Local anesthetics from the amide group may lead to symptoms of the central nervous system (CNS) such as depression, seizures or altered mental state, while they may lead to arrhythmia in the cardiovascular system (CVS). The causes of the neurologic complications observed with spinal local anesthetics are the administration of high doses, rapid entry into the systemic circulation, erroneous administration through the IV route, or the diffusion of the drug towards the cephalic region. Bupivacaine is among the most commonly used local anesthetics from the amide group. However rare, neurological injury after administered bupivacaine can be distressing to patients and their families. In our patient, we have administered bupivacaine through the intrathecal route. Thus, we would like to present a case where status epilepticus in the form of generalised tonic-clonic seizures (GTC) has developed subsequent to the intrathecal administration of bupivacaine. J Clin Exp Invest 2014; 5 (1): 108-111

Anahtar Kelimeler

Local anesthetics, status epilepticus, bupivacaine

Status epilepticus induced by intrathecal bupivacaine use: A case report

Öz

Lokal anestezikler anestezik ve postoperatif analjezik olarak sıkça kullanılmaktadırlar. Bupivakain en sık kullanılan amid grubu lokal anestezik maddelerden biridir. Amid grubu lokal anesteziklerin santral sinir sistem(SSS)’de depresyon, nöbet ve bilinç değişikliğine neden olurken kardiyovaskuler sistem (KVS)’de aritmilere yol açmaktadır. Spinal lokal anesteziklerin nörolojik komplikasyonların nedenleri ilacın yüksek dozda verilmesi, hızla sistemik dolaşıma geçmesi, yanlışlıkla İV verilmesi ya da ilacın sefale doğru yayılmasıdır. Bizim olgumuzda intratekal bupivakain kullanıldı. İntratekal bupivakain kullanımına bağlı jeneralize myoklonik nöbet bildirilmişitir. Ancak araştırmalarımıza göre intratekal bupivakain kullanıma bağlı Jeneralize tonik klonik (JTK) tarzda status epileptikus olgusu bildirilmemiştir. Olgumuz intratekal bupivakain kullanım sonrası gelişen JTK tarzda status epileptikus vakası olması nedeni ile sunuldu

Anahtar Kelimeler

Lokal anestezikler, status epileptikus, bupivakain

Kaynakça

• Akerman B, Hellberg IB, Trossvik C. Primary evaluation of the local anesthetic properties of the amino amide agent ropivacaine (LEA 103). Acta Anesthesiol Scand 1988;32:571-578.
• Naguib M, Magboul MM, Samarkandi AH, et al. Adverse effects and drug interactions associated with local and regional anesthesia. Drug safety 1988;18:221-250.
• Batra YK, Rajeev S, Lokesh VC, et al. Spinal myoclo- nus associated with intrathecal bupivacaine and fen- tanyl in an infant. Can J Anesth 2007;54:587-588.
• Hodgson PS, Neal JM, Pollock JE,et al. The neurotox- icity of drugs given intrathecally (spinal). Anesth Analg 1999; 88:797-809.
• Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990-1999. Anesthesiology 2004; 101:950- 959.
• Huang YF, Pryor ME, Mather LE, et al. Cardiovascu- lar and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesth Analg 1998;86:797-804.
• Crews JC, Rothman TE. Seizure after levobupivacaine for interscalene brachial plexus block. Anesth Analg. 2003;96:1188-1190.
• Abouleish EI, Elias M, Nelson C. Ropivacaine-induced seizure after extradural anesthesia. Br J Anaesth 1998;80:843-844.
• Fragneto RY, Fisher A. Mental status change and aphasia after labor analgesia with intrathecal sufen- tanil/bupivacaine. Anesth Analg 2000; 90:1175-1176.
• Scavone BM. Altered level of consciousness after combined spinal-epidural labor analgesia with in- trathecal fentanyl and bupivacaine. Anesthesiology 2002;96:1021-1022.
• Knudsen K, Beckman Suurkula M, Blomberg S, et al. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 1997;78:507-514.
• Loke GP, Chan EH, Sia AT. The effect of 10 degrees head-up tilt in the right lateral position on the systemic blood pressure after subarachnoid block for Caesar- ean section. Anesthesia 2002;57:169-172.
• Ding ZN, Yoshita Y, Hirota K, et al. Brainstem auditory evoked potentials during procaine toxicity in dogs. Can J Anesth 1992;39:600-603.
• Oda Y, Funao T, Tanaka K, et al. Vasodilation increas- es the threshold for bupivacaine-induced convulsions in rats. Anesth Analg 2004;98:677-682.
• Yılmaz M, Yeğin A, Döşemeci L, et al. Bupivakaine Bağlı Toksik Reaksiyon: Konvülziyon ve Kalıcı Şuur Kaybı. Türk Anest Rean Der 2005;33:490-493.