Case 7: Generalized Convulsions After Regional Anesthesia

Abstract

A 16-year-old boy (50 kg) is admitted in the early hours of the morning for repair of a cut right ulnar nerve. He is under the influence of alcohol and states that he has neither eaten nor drunk anything for 5 h. His vital signs are stable and his hemoglobin is 11 g%. He has no fixed address and denies any medical problems or illicit drug use. He comes to the operating room with an intravenous (IV) infusion of lactated Ringer’s solution. He has received a total of 1 l since admission 2 h earlier. At 4:00 a.m., a supraclavicular brachial plexus block is performed with a mixture of 1.5 mg/kg (20 ml) bupivacaine 0.5 % and 1.5 mg/kg lidocaine 1 % (10 ml). At 4:20 a.m., surgery starts. Five minutes later (4:25 a.m.), the patient develops what appear to be generalized convulsions. However, he is breathing, and oxygen saturation remains within acceptable limits above 95 %. His heart rate is 94 regular, and his blood pressure (BP) is 140/90.