title: Toxic plasma concentration of ropivacaine after a paravertebral block in a patient suffering from severe hypoalbuminemia.
abstract: A case of systemic ropivacaine toxicity from a continuous thoracic paravertebral block in an adult patient who received a lobectomy is presented. The catheter was placed by the surgeon. Eleven hours after the start of the infusion, the patient experienced an arrhythmia leading to death. The total venous plasma concentration of ropivacaine was high (3.2 μg/mL). Furthermore, the patient had severe hypoalbuminemia (albumin 24 g/L), which resulted in the increase of the unbound ropivacaine plasma concentration that was responsible for the toxic side effects.
authors.affiliation: Service d'Anesthésie et Réanimation Chirurgicale, Rouen University Hospital, Hôpital Charles-Nicolle, 1 rue de Germont, 76031, Rouen Cedex, France. Electronic address: emile.calenda@chu-rouen.fr.
authors.forename: Emile
authors.initials: E
authors.lastname: Calenda
authors.affiliation: Service de Chirurgie Thoracique et Cardiovasculaire, Rouen University Hospital, Hôpital Charles-Nicolle, 1 rue de Germont, 76031, Rouen Cedex, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Baste
authors.affiliation: Service d'Anesthésie et Réanimation Chirurgicale, Rouen University Hospital, Hôpital Charles-Nicolle, 1 rue de Germont, 76031, Rouen Cedex, France.
authors.forename: Ridha
authors.initials: R
authors.lastname: Hajjej
authors.affiliation: Service d'Anesthésie et Réanimation Chirurgicale, Rouen University Hospital, Hôpital Charles-Nicolle, 1 rue de Germont, 76031, Rouen Cedex, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Danielou
authors.affiliation: Service de Chirurgie Thoracique et Cardiovasculaire, Rouen University Hospital, Hôpital Charles-Nicolle, 1 rue de Germont, 76031, Rouen Cedex, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Peillon
mesh_terms: D000368:Aged; D000577:Amides / Q000097:blood / Q000633:toxicity*; D000779:Anesthetics, Local / Q000633:toxicity*; D006801:Humans; D034141:Hypoalbuminemia / Q000378:metabolism*; D008297:Male; D009407:Nerve Block / Q000009:adverse effects*; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: Hypoalbuminemia; Ropivacaine: plasma concentration; Thoracic paravertebral block