Generalized tonic-clonic seizure following spinal anesthesia for Cesarean section with bupivacaine: A case report

Regional anesthesia for Cesarean section is a popular anesthetic method and a subarachnoid injection of local anesthetics provides rapid onset and a reliable block. Furthermore, it maintains airway reflexes and consciousness of the parturient and is associated with less neonatal depression. Complications related with spinal anesthesia are most often postdural puncture headache, back pain, hematoma, abscess, paresthesia or motor weakness and very rarely, myoclonus. Generalized seizures as a complication following epidural anesthesia with bupivacaine has been reported, but rarely following spinal anesthesia. We present a case of a parturient who was well antenatally, but presented with generalized tonic-clonic seizures following delivery. Although the possible etiologic factors of these transient seizures after spinal anesthesia are difficult to clarify, we emphasize that careful airway monitoring after regional anesthesia is important.

Clinical factors affecting the pain on injection of propofol / 대한마취과학회지

BACKGROUND: Pain on propofol injection is a well-known adverse effect. We evaluated the clinical factors that affect the pain on injection of propofol to develop a strategy to prevent or reduce pain. METHODS: We conducted a prospective, observational study of 207 adult patients (ASA I-II), and the patients were classified according to gender, age, the body mass index (BMI), the IV site and the side of the IV site. During the 10 seconds after propofol injection, pain intensity was measured on an 11-point numerical rating scale (0 = no pain and 10 = worst possible pain). Pain in excess of 3 on the numerical scale was regarded as moderate to severe pain. RESULTS: The subgroups of gender (female: 55.6% vs. male: 25.0%; P < 0.01) and the IV site (dorsum of hand: 61.2% vs. wrist: 40.0% vs. antecubital fossa: 22.5%; P < 0.01) had significantly different frequencies for the incidence of pain on injection on the univariate and multivariate analyses. For the subgroup of females, the incidence of pain was statistically different according to the age group (20-40 yr: 71.0% vs. 41-60: 54.8% vs. 61-80: 38.5%; P = 0.014). CONCLUSIONS: Our results showed that the younger age patients, the patients with a peripheral IV site and female patients are more sensitive to pain on the injection of propofol.