title: Two for One: A Case Report of Intravenous Lipid Emulsion to Treat Local Anesthetic Systemic Toxicity in Term Pregnancy.
abstract: Combined spinal-epidural (CSE) analgesia is a frequently used method of labor analgesia. Although it is considered safe and effective, CSE can be complicated by local anesthetic systemic toxicity (LAST), a potentially life-threatening condition. We present a case of LAST that developed in a primigravida 50 minutes after uneventful placement of a CSE. Her symptoms resolved within 10 minutes of administering intralipid emulsion. She subsequently underwent cesarean delivery under spinal anesthesia for failure to progress without sequelae in the mother or infant. LAST in pregnancy can occur at traditionally subthreshold dosing; anesthesiologists must be vigilant to ensure prompt and effective treatment.
authors.affiliation: From the *Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; †Department of Anesthesiology, Jackson Memorial Hospital, Miami, Florida; ‡Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; and §Department of Anesthesiology, University of Miami, Miami, Florida.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dun-Chi Lin
authors.forename: Eellan
authors.initials: E
authors.lastname: Sivanesan
authors.forename: Terese T
authors.initials: TT
authors.lastname: Horlocker
authors.forename: Andres
authors.initials: A
authors.lastname: Missair
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000379:methods; D016362:Analgesia, Obstetrical / Q000009:adverse effects* / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000506:poisoning*; D000931:Antidotes / Q000008:administration & dosage*; D002585:Cesarean Section; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D060186:Infusions, Spinal; D008012:Lidocaine / Q000008:administration & dosage / Q000506:poisoning*; D011041:Poisoning / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D011247:Pregnancy; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000931:Antidotes; D005217:Fat Emulsions, Intravenous; D008012:Lidocaine