title: Seizure After Abdominal Surgery in an Infant Receiving a Standard-Dose Postoperative Epidural Bupivacaine Infusion.
abstract: We present the case of an otherwise healthy 12-month-old girl undergoing repair of a giant omphalocele, who experienced a postoperative seizure attributed to accumulation of bupivacaine from an epidural infusion. Whereas a standard dose was used, this patient experienced temporary liver dysfunction postoperatively, presumably from elevated intra-abdominal pressures, predisposing her to toxicity after a prolonged infusion. This case illustrates how the type of surgery can influence the margin of safety of routinely used neuraxial local anesthetic doses in infants and young children.
authors.affiliation: From the Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Peter
authors.initials: P
authors.lastname: Shapiro
authors.forename: Hedwig
authors.initials: H
authors.lastname: Schroeck
mesh_terms: D000779:Anesthetics, Local / Q000009:adverse effects*; D002045:Bupivacaine / Q000009:adverse effects*; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D006801:Humans; D007223:Infant; D011184:Postoperative Period; D012640:Seizures / Q000139:chemically induced*
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine