Skip to main content

Seizures in a Child After Caudal Block for Circumcision

  • Chapter
  • First Online:
Anesthesia STAT! Acute Pediatric Emergencies in PACU
  • 263 Accesses

Abstract

This is a case of postoperative seizures in an infant after circumcision. The case stem follows a routine anesthetic with standard medications and care who develops rhythmic convulsions in the PACU shortly after arrival. Measures are taken to stabilize the patient’s cardiopulmonary function. Clinical signs, laboratory tests, and intraoperative events lead to a diagnosis of local anesthesia toxicity. Medications are administered to treat the active seizures and the local anesthetic toxicity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Fine A, Wirrell EC. Seizures in children. Pediatr Rev. 2020;41(7):321–47. https://doi.org/10.1542/pir.2019-0134.

    Article  PubMed  Google Scholar 

  2. Fisher RS, et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):522–30.

    Article  PubMed  Google Scholar 

  3. Zhou KQ, McDouall A, Drury PP, Lear CA, Cho KHT, Bennet L, Gunn AJ, Davidson JO. Treating seizures after hypoxic-ischemic encephalopathy-current controversies and future directions. Int J Mol Sci. 2021;22(13):7121. https://doi.org/10.3390/ijms22137121. PMID: 34281174; PMCID: PMC8268683

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Nardone R, Brigo F, Trinka E. Acute symptomatic seizures caused by electrolyte disturbances. J Clin Neurol. 2016;12(1):21–33. https://doi.org/10.3988/jcn.2016.12.1.21. PMID: 26754778; PMCID: PMC4712283

    Article  PubMed  Google Scholar 

  5. Imad H, Zelano J, Kumlien E. Hypoglycemia, and risk of seizures: a retrospective cross-sectional study. Seizure. 2015;25:147–9. https://doi.org/10.1016/j.seizure.2014.10.005. Epub 2014 Oct 17. Erratum in: Seizure. 2017; 45:132. Johan, Zelano [corrected to Zelano, Johan]; Eva, Kumlien [corrected to Kumlien, Eva]. PMID: 25455725

    Article  PubMed  Google Scholar 

  6. Fawcett WJ, Thomas M. Pre-operative fasting in adults and children: clinical practice and guidelines. Anaesthesia. 2019;74(1):83–8. https://doi.org/10.1111/anae.14500. Epub 2018 Nov 30. PMID: 30500064

    Article  CAS  PubMed  Google Scholar 

  7. Maze A, Samuels SI. Hypoglycemia-induced seizures in an infant during anesthesia. Anesthesiology. 1980;52:77. https://doi.org/10.1097/00000542-198001000-00017.

    Article  CAS  PubMed  Google Scholar 

  8. Holland KE, Frieden IJ, Frommelt PC, Mancini AJ, Wyatt D, Drolet BA. Hypoglycemia in children taking propranolol for the treatment of infantile hemangioma. Arch Dermatol. 2010;146(7):775–8. https://doi.org/10.1001/archdermatol.2010.158.

    Article  CAS  PubMed  Google Scholar 

  9. Voss LJ, Sleigh JW, Barnard JP, Kirsch HE. The howling cortex: seizures and general anesthetic drugs. Anesth Analg. 2008;107(5):1689–703. https://doi.org/10.1213/ane.0b013e3181852595. PMID: 18931234

    Article  PubMed  Google Scholar 

  10. Dontukurthy S, Tobias JD. Update on local anesthetic toxicity, prevention and treatment during regional anesthesia in infants and children. J Pediatr Pharmacol Ther. 2021;26(5):445–54. https://doi.org/10.5863/1551-6776-26.5.445. Epub 2021 Jun 28. PMID: 34239395; PMCID: PMC8244955

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lönnqvist PA. Toxicity of local anesthetic drugs: a pediatric perspective. Paediatr Anaesth. 2012;22(1):39–43. https://doi.org/10.1111/j.1460-9592.2011.03631.x. Epub 2011 Jun 14. PMID: 21672079

    Article  PubMed  Google Scholar 

  12. Zink W, Graf BM. The toxicity of local anesthetics: the place of ropivacaine and levobupivacaine. Curr Opin Anaesthesiol. 2008;21(5):645–50. https://doi.org/10.1097/ACO.0b013e32830c214c. PMID: 18784493

    Article  PubMed  Google Scholar 

  13. Neal JM, Bernards CM, Butterworth JF 4th, Di Gregorio G, Drasner K, Hejtmanek MR, Mulroy MF, Rosenquist RW, Weinberg GL. ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med. 2010;35(2):152–61. https://doi.org/10.1097/AAP.0b013e3181d22fcd. PMID: 20216033

    Article  PubMed  Google Scholar 

  14. El-Boghdadly K, Chin KJ. Local anesthetic systemic toxicity: continuing professional development. Can J Anaesth. 2016;63(3):330–49. https://doi.org/10.1007/s12630-015-0564-z. Epub 2016 Jan 29. PMID: 26830640

    Article  PubMed  Google Scholar 

  15. Gitman M, Barrington MJ. Local anesthetic systemic toxicity: a review of recent case reports and registries. Reg Anesth Pain Med. 2018;43(2):124–30. https://doi.org/10.1097/AAP.0000000000000721. PMID: 29303925

    Article  PubMed  Google Scholar 

  16. El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current perspectives. Local Reg Anesth. 2018;11:35–44. https://doi.org/10.2147/LRA.S154512. PMID: 30122981; PMCID: PMC6087022

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Di Gregorio G, Neal JM, Rosenquist RW, Weinberg GL. Clinical presentation of local anesthetic systemic toxicity: a review of published cases, 1979 to 2009. Reg Anesth Pain Med. 2010;35(2):181–7. https://doi.org/10.1097/aap.0b013e3181d2310b. PMID: 20301824

    Article  PubMed  Google Scholar 

  18. Kil HK. Caudal and epidural blocks in infants and small children: historical perspective and ultrasound-guided approaches. Korean J Anesthesiol. 2018;71(6):430–9. https://doi.org/10.4097/kja.d.18.00109. Epub 2018 Aug 8. PMID: 30086609; PMCID: PMC6283718

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ok SH, Hong JM, Lee SH, Sohn JT. Lipid emulsion for treating local anesthetic systemic toxicity. Int J Med Sci. 2018;15(7):713–22. https://doi.org/10.7150/ijms.22643. PMID: 29910676; PMCID: PMC6001420

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Presley JD, Chyka PA. Intravenous lipid emulsion to reverse acute drug toxicity in pediatric patients. Ann Pharmacother. 2013;47(5):735–43. https://doi.org/10.1345/aph.1R666. Epub 2013 Apr 23. PMID: 23613099

    Article  CAS  PubMed  Google Scholar 

  21. Havan M, Kendirli T, Ă–zcan S, DoÄŸan MT, YiÄŸit AO, Uçar T. A successful treatment with intravenous lipid emulsion therapy in a child with verapamil poisoning. Turk J Emerg Med. 2021;21(4):217–20. https://doi.org/10.4103/2452-2473.329626. PMID: 34849436; PMCID: PMC8593422

    Article  PubMed  PubMed Central  Google Scholar 

  22. Safety Committee of Japanese Society of Anesthesiologists. Practical guide for the management of systemic toxicity caused by local anesthetics. J Anesth. 2019;33(1):1–8. https://doi.org/10.1007/s00540-018-2542-4. Epub 2018 Nov 11. PMID: 30417244

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew T. Waberski .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Waberski, A.T. (2023). Seizures in a Child After Caudal Block for Circumcision. In: Verghese, S.T. (eds) Anesthesia STAT! Acute Pediatric Emergencies in PACU. Springer, Cham. https://doi.org/10.1007/978-3-031-24396-7_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-24396-7_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-24395-0

  • Online ISBN: 978-3-031-24396-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics