Eşref AKIL, Sefer VAROL, Cüneyt GÖÇMEZ, Abdulmenaf GÜZEL

Status epilepticus induced by intrathecal bupivacaine use: A case report

Lokal anestezikler anestezik ve postoperatif analjezik olarak sıkça kullanılmaktadırlar. Bupivakain en sık kullanılan amid grubu lokal anestezik maddelerden biridir. Amid grubu lokal anesteziklerin santral sinir sistem(SSS)'de depresyon, nöbet ve bilinç değişikliğine neden olurken kardiyovaskuler sistem (KVS)'de aritmilere yol açmaktadır. Spinal lokal anesteziklerin nörolojik komplikasyonların nedenleri ilacın yüksek dozda verilmesi, hızla sistemik dolaşıma geçmesi, yanlışlıkla İV verilmesi ya da ilacın sefale doğru yayılmasıdır. Bizim olgumuzda intratekal bupivakain kullanıldı. İntratekal bupivakain kullanımına bağlı jeneralize myoklonik nöbet bildirilmişitir. Ancak araştırmalarımıza göre intratekal bupivakain kullanıma bağlı Jeneralize tonik klonik (JTK) tarzda status epileptikus olgusu bildirilmemiştir. Olgumuz intratekal bupivakain kullanım sonrası gelişen JTK tarzda status epileptikus vakası olması nedeni ile sunuldu.

İntratekal bupivakain kullanımına bağlı status epileptikus: Olgu sunumu

Local anesthetics are commonly used as analgesics and anesthetics. Local anesthetics from the amide group may lead to symptoms of the central nervous system (CNS) such as depression, seizures or altered mental state, while they may lead to arrhythmia in the cardiovascular system (CVS). The causes of the neurologic complications observed with spinal local anesthetics are the administration of high doses, rapid entry into the systemic circulation, erroneous administration through the IV route, or the diffusion of the drug towards the cephalic region. Bupivacaine is among the most commonly used local anesthetics from the amide group. However rare, neurological injury after administered bupivacaine can be distressing to patients and their families. In our patient, we have administered bupivacaine through the intrathecal route. Thus, we would like to present a case where status epilepticus in the form of generalised tonic-clonic seizures (GTC) has developed subsequent to the intrathecal administration of bupivacaine.

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