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Local Anesthetic Toxicity

Local Anesthetic Toxicity

“…gentle aspiration was performed and was negative for blood. Approximately one minute after the local anesthetic administration, the patient became anxious, then obtunded and began to seize.”

Case Context    Provider Narrative    Contributing Factors    Lessons Learned

Case Context

Patient: older adult female Ht: Not provided Wt: Not provided
Presenting diagnosis: osteoarthritis
Planned procedure: left total knee replacement
Past medical history: Allergies: codeine, sulfa, nitrofurantoin; hypertension; gastroesophageal reflux disease (GERD); hypercholesterolemia
Preoperative meds: quinapril, fish oil, diclofenac, ibuprofen, hydrochlorothiazide, omeprazole, simvastatin, and fexofenadine
Other pertinent details: pre-operative evaluation unremarkable except for hypertension and an IVCD without acute ischemic changes
Anesthetic plan: general endotracheal anesthesia with a “single-shot” femoral block for postoperative analgesia 


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