title: [A case of delayed arousal after anesthesia due to aberrant epidural catheter placement in a blood vessel].
abstract: A 71-year-old man underwent a total gastrectomy. An epidural catheter was inserted before the induction of general anesthesia. Blood was withdrawn from an epidural catheter inserted at T8-9 interspace with a median approach. The epidural catheter was then reinserted in T8-9 interspace with a paramedian approach and neither blood nor cerebrospinal fluid was withdrawn with careful aspiration. The catheter placement was confirmed with 1% lidocaine 3 ml. Anesthesia was induced with fentanyl, propofol, and rocuronium, and was maintained with sevoflurane, oxygen, air, fentanyl, and epidural analgesia. Total of 0.375% ropivacaine 15 ml was administered through the epidural catheter in about 1 hr. All anesthetics but continuous epidural analgesia with 0.2% ropivacaine at a speed of 4 ml x hr(-1) were terminated when the operation was completed; however, the patient was not arousable for 2 hours thereafter. When we carefully aspirated the epidural catheter, fresh blood was withdrawn from the catheter. We confirmed that the delayed arousal was due to the administration of ropivacaine into the blood by aberrant epidural catheter placement in a blood vessel. Unaccountable tachycardia and mild hypertension observed persistently during the operation would have been the warning to the toxicity of local anesthetics during general anesthesia.
authors.forename: Kana
authors.initials: K
authors.lastname: Akimoto
authors.forename: Chiyori
authors.initials: C
authors.lastname: Yamauchi
authors.forename: Keiko
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Kiyoyasu
authors.initials: K
authors.lastname: Kurahashi
mesh_terms: D000368:Aged; D000577:Amides / Q000009:adverse effects; D000767:Anesthesia, Epidural / Q000295:instrumentation*; D000779:Anesthetics, Local / Q000009:adverse effects; D057785:Catheters / Q000009:adverse effects*; D055191:Delayed Emergence from Anesthesia / Q000209:etiology*; D005548:Foreign-Body Migration / Q000150:complications*; D005743:Gastrectomy; D006801:Humans; D008297:Male; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine