Convulsion and cardiorespiratory collapse with first epidural test dose

摘要

Accidental intravascular injection of local anesthetic can cause central nervous system (CNS) toxicity, presenting as tremors, convulsions, dysrhythmias, and cardiorespiratory arrest. During epidural anesthesia, a test dose is used to diagnose inadvertent intravascular or intrathecal administration of drugs. We present a case where the test dose itself caused central neural toxicity. A 38-year-old woman, weighing 50 kg and 159 cm tall, with chondrosarcoma in the left femur, presented for tumor resection, irradiation, and reconstruction under a combined epidural and general anesthesia. She had no significant past or family medical history, with no associated comorbid illnesses or evidence of metastasis. She was positioned in the right lateral position for insertion of an epidural catheter under monitoring of heart rate (HR), blood pressure (BP), and oxygen saturation (SpO_2).