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[THE USE OF 20% LIPOFUNDIN INFUSIONS AT THE APPEARANCE OF TOXIC PROPERTIES OF ROPIVACAINE 2 MG/ML IN CHILD 1.5 MONTHS

S Yu Sichkar, I I Afukov, O V Koshko

    Anesteziologiia I Reanimatologiia
    |May 20, 2016
    PubMed

    Insights

    Epidural analgesia with ropivacaine in infants is effective but carries risks. Lipofundin infusion successfully treated seizures in a 1.5-month-old infant experiencing toxicity from epidural ropivacaine.

    Area of Science:

    • Pediatric Anesthesiology
    • Pharmacology
    • Nephrology

    Background:

    • Epidural (EP) analgesia is a safe and effective method for intra- and post-operative pain management in children.
    • Lower dosages of ropivacaine (2 mg/kg) are used in infants under 6 months due to age-specific factors.
    • Systemic toxicity from local anesthetics can be treated with 20% lipofundin infusion.

    Observation:

    • A 1.5-month-old infant with congenital kidney abnormalities underwent laparoscopic nephroureterectomy.
    • During post-operative epidural analgesia with ropivacaine (0.2 mg/kg/hr), the infant experienced recurrent seizures.
    • These seizures were attributed to the toxic effects of the local anesthetic.

    Findings:

    • A 20% lipofundin infusion (15 ml, 2.8 ml/kg) administered over 30 minutes effectively resolved the seizure episodes.
    • The successful treatment allowed for the continuation of epidural analgesia.

    Implications:

    • This case highlights the potential for ropivacaine toxicity in infants even at standard dosages.
    • Lipofundin is a viable and effective antidote for local anesthetic systemic toxicity (LAST) in pediatric patients.
    • Careful monitoring and prompt intervention are crucial when using epidural analgesia in neonates and infants.

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