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Convulsions during superior laryngeal nerve block--a case report
1Department of Anesthesiology, Tri-Service General Hospital, Taipei, Taiwan, R.O.C.
Acta Anaesthesiologica Sinica
|September 23, 2000
Summary
Complications from local anesthesia during fiberoscope-assisted intubation are rare. Accidental injection into the vertebral artery during a superior laryngeal nerve block can cause central nervous system toxicity and convulsions.
Area of Science:
- Anesthesiology
- Neurology
Background:
- Fiberoscope-assisted intubation is a common procedure for airway management.
- Local anesthesia, including superior laryngeal nerve block, is frequently used to facilitate awake intubation.
- Complications, such as central nervous system toxicity, are rare but possible.
Observation:
- A case report details a patient experiencing convulsions after a left superior laryngeal nerve block for awake intubation.
- The suspected cause was inadvertent injection of local anesthetic into the vertebral artery.
- Even small amounts of local anesthetic can cause toxicity if injected intravascularly.
Findings:
- Central nervous system toxicity of local anesthetics is influenced by dose, injection rate, and injection site.
- Accidental intravascular injection, particularly into the vertebral artery, can lead to rapid systemic absorption and neurological adverse events.
- This case highlights a rare but serious complication of superior laryngeal nerve block.
Implications:
- Careful technique and aspiration before injection are crucial during nerve blocks.
- Starting with small doses and continuous patient monitoring is recommended for neck nerve blocks.
- Availability of resuscitation equipment is essential for managing potential emergencies like local anesthetic systemic toxicity (LAST).