A patient convulsed 45 minutes after a technically uncomplicated epidural anesthetic with 150 mg bupivacaine, while she was being moved from the supine to the prone position. The following explanation is discussed. Changing the patient's position may have lead to a compression of the inferior vena cava and thus to an increased collateral flow in the internal vertebral venous plexus. A bolus of local anesthetic, which had accumulated there due to sluggish blood flow, thereby may have been ejected from the venous plexus into the general systemic circulation.
- Anesthetic techniques
- epidural analgesia
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Address reprint requests to Dr. Lanz: Institut für Anaesthesiologie der Universität, Langenbeckstr. 1, 6500 Mainz, West Germany.