Southern medical journal
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Southern medical journal · Nov 1975
Case ReportsAcute systemic toxicity from bupivacaine during epidural anesthesia in obstetric patients.
Convulsions occurred within 30 seconds after the injection of bupivacaine through the epidural catheter in four obstetric patients in labor, and mild excitation without convulsions occurred in three others. Since the time between injection and the reaction was so short and since the dose was so small, the response probably was due to intravenous injection resulting from lodgement of the catheter in a vein, rather than to absorption from the epidural space itself. ⋯ Other colleagues have had similar though unreported experiences. Physicians performing epidural blocks should be aware that such an occurrence is possible and that the catheter may be within a vein without blood returning on aspiration.
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Chest and abdominal radiograms are most helpful in evaluating acute abdominal pain in children. When basilar pneumonia is found the likelihood of associated appendicitis is slim. ⋯ The likelihood of appendicitis is great when the appendix fails to fill at the time of barium enema. Complete filling of the appendix excludes the possibility of acute appendicitis.