Case Discussion Part 2: Would You Proceed?

By Amit Pawa, BSc(Hons), MBBS(Hons), FRCA, EDRA    Aug 22, 2016

Last week, we posed a case scenario of an 82-year-old woman with a history of hypertension, hyperlipidemia, tobacco use, and atrial fibrillation who presented for a total knee arthroplasty. While undergoing an ultrasound-guided adductor canal block, the patient experienced local anesthetic systemic toxicity. In a Twitter-based poll, we posed the question, "would you administer fat emulsion? Why or why not?"

We'll present the full report of this case scenario and expert opinions in the November 2016 ASRA News.

Part 2 of our case scenario picks up here with our second Twitter-based problem-based learning discussion (PBLD) with poll.  Please share your thoughts and retweet the poll to your followers.


Case Scenario, Part 2

The patient did not receive lipid emulsion.  She remained hemodynamically stable and within a couple of minutes was responding to name and opening eyes. Around 5 minutes after the event, the patient was sleepy but oriented and was able to answer questions.

Around 30 minutes after the event, and despite 4 mg of midazolam, the patient seemed to be alert and awake.  In the hours following this event, the patient repeatedly stated her desire to proceed with surgery, despite the LAST event, saying that she feels well. Her husband and daughter are summoned to bedside. The event was described entirely to the patient and family. They collectively defer to your judgment on the question of whether to proceed with surgery.


Would you proceed with the case? Why or why not?

Would you block again or not?

Click here to contribute to the poll and discussion.


Dr. Amit Pawa, BSc(Hons) MBBS(Hons) FRCA EDRA, is a consultant anaesthetist, Specialty & Educational Lead for Regional Anaesthesia, at Guy's & St Thomas' NHS Foundation Trust, Department of Anaesthesia, St Thomas' Hospital, in London. He is also an Academic Lead for the London Society of Regional Anaesthesia (LSORA) and a member of the Board of Regional Anaesthesia - UK (RA-UK). @amit_pawa


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