REGIONAL ANESTHESIA AND LOCAL ANESTHETIC-INDUCED SYSTEMIC TOXICITY - SEIZURE FREQUENCY AND ACCOMPANYING CARDIOVASCULAR CHANGES

We sought to determine the contemporary frequency of seizures, and the associated cardiovascular changes, resulting from local anesthetic-in duced seizures in all patients undergoing brachial plexus, epidural, a nd caudal regional anesthetics. We investigated the following variable s: development and treatment of seizure or cardiac arrest during the r egional anesthetic, type of anesthetic (including local anesthetic use d), gender, age, ASA physical status class and type of operation (elec tive or emergent). In addition, each patient who experienced a seizure underwent retrospective review of the acute event to determine the ar terial blood pressure and heart rate changes accompanying the seizure, as well as details of the regional block technique. There was a signi ficant difference between the rate of seizure development between epid ural, brachia, and caudal anesthetics, with caudal > brachial > epidur al. A significant difference was also noted in the rate of seizure dev elopment within types of brachial block, with supraclavicular and inte rscalene > axillary. No adverse cardiovascular, pulmonary or nervous s ystem events were associated with any of the seizures, including the 1 6 patients who received bupivacaine blocks. The frequency of local ane sthetic-induced seizures stratified by block type has a wide range, an d cardiovascular collapse after bupivacaine-associated seizure has a l ow incidence.