Transient perioperative brainstem paralysis secondary to a local anesthetic.
Local anesthesia is widely used, in isolation or in conjunction with general anesthesia. The authors describe 2 adolescent patients presenting with absent brainstem reflexes and delayed awakening following elective foramen magnum decompression for Chiari Type I malformation. In both cases, neurological deficits were closely associated with the administration of a levobupivacaine field block following wound closure. In the absence of any structural or biochemical abnormalities, and with spontaneous recovery approximating the anesthetic half-life, the authors' observations are consistent with transient brainstem paralysis caused by perioperative local anesthetic infiltration.
Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom. aj238@cam.ac.uk
Alexis J
AJ
Joannides
Thomas
T
Santarius
Helen M
HM
Fernandes
Rodney J C
RJ
Laing
Rikin A
RA
Trivedi
D000293:Adolescent; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D001139:Arnold-Chiari Malformation / Q000601:surgery*; D001933:Brain Stem / Q000187:drug effects* / Q000503:physiopathology*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D019299:Decompression, Surgical; D005260:Female; D006207:Half-Life; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D010243:Paralysis / Q000139:chemically induced* / Q000503:physiopathology; D059035:Perioperative Period; D012025:Reflex, Pupillary
D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine