Cliniquiz

Local anesthetics: pharmacology & clinical application

Kirti Ahuja*, Jagdish Dureja**, Pranav Bansal***, Puja Singal*

*Assistant Professor; **Professor and Head; ***Associate Professor

Dept. of Anesthesiology, BPS GMCW, Khanpur Kalan, Sonepat Haryana (India)

A 35 year old male patient is taken up for orthopedic fixation of left humerus. The anesthesiologist performs interscalene block on ipsilateral side to provide surgical anesthesia of upper limb. After completion of procedure, the patient immediately starts complaining of numbness around the face, talks irrelevantly which progresses to incoherent speech. Involuntary jerky movements of upper extremities and facial region begin which progress to generalized tonic-clonic convulsions. Understanding the nature of complication, the anesthesia provider looks rapidly injects midazolam 2 mg and propofol 7-8 ml intravenously in the convulsing patient. As thipentone is prepared, he injects 100 mg of drug intravenously following which, the seizures are abolished. The surgery is started and surgical procedure completed under regional anesthesia.

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REFERENCES

  1. Heavner JE. Pharmacology of Local Anesthetics Ch 44. Anaesthesiology; Ed.David E. Longnecker 2nd McGraw Hill publishers: Pg. 954-70.
  2. Berde CB, Strichartz GR. Local Anesthetics Ch 30. Miller’s Textbook of anaesthesia. 7th Ed. Ronald D. Miller. Churchill Livingstone, Elsevier publishers.