A 23 year-old woman was full term pregnancy was admitted to the obstetric ward in the first stage of labor. A long-acting epidural block was proposed for analgesia.
case author: Hugh S. Mathewson, M.D., Professor Emeritus, School of Allied Health, Department of Nurse Anesthesia, University of Kansas Medical Center
case editor: Michael Gordon, Ph.D.
Which local anesthetic drug is most suitable for this patient?
chloroprocaine (Nesacaine)
lidocaine (Xylocaine)
bupivacaine (Marcaine)
etidocaine (Duranest)
all are appropriate
What is the chief risk associated with bupivacaine (Marcaine) administration?
renal toxicity
pulmonary hypertension
inadequate anesthesia
cardiotoxicity
seizures
What are signs of cardiotoxicity?
myocardial depression (hypotension)
ventricular arrhythmias
cardiac arrest (in extreme cases)
B & C
A, B & C
How can the risk of cardiotoxicity be reduced?
Use a fairly dilute bupivacaine (Marcaine) solution
use a test dose after placement of epidural catheter
if a second injection is required, aspiration of the catheter should be performed and recorded