Question

15B-118. 20mls of 0.5% Bupivacaine is inadvertently injected into an epidural vein over 30 seconds. The patient is 30 years old, pregnant and weighs 60kg. The most likely outcome would be:

A. tinnitus and sinus tachycardia
B. confusion and atrial ectopics
C. grand mal seizure and hypotension
D. focal seizure and torsades de pointes
E. muscle twitching and heart block

Answer 1

The most likely outcome of the inadvertent injection is a grand mal seizure and hypotension due to the CNS and cardiovascular effects of Bupivacaine.

Step-by-step explanation:

The most likely outcome following the inadvertent injection of 20mls of 0.5% Bupivacaine into an epidural vein over 30 seconds in a 30-year-old pregnant woman weighing 60kg would be C. grand mal seizure and hypotension. Bupivacaine is a potent local anesthetic that can cause central nervous system (CNS) and cardiovascular toxicity if injected intravascularly. CNS toxicity manifests as a spectrum starting from tinnitus and muscle twitching to grand mal seizures, and cardiovascular toxicity can result in hypotension, arrhythmias, and even cardiac arrest.

The options provided in the question are different possible adverse reactions to the drug. However, given the high dose and rapid injection, a grand mal seizure due to CNS overstimulation is likely. Hypotension may occur due to cardiovascular effects. Other early signs of bupivacaine toxicity include tinnitus, muscle twitching, and confusion, but these are more likely at lower levels of exposure.