Local anesthetic death

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
2

24858

ABC News
Atlanta Child, 5, Dies From Local Anesthesia
By MIKAELA CONLEY
2 hours, 24 minutes ago

Five-year-old Kensley Kirby was taken to an Atlanta urgent care center to get treated for a broken arm, but died from a lethal dose of local anesthesia given to her at the clinic, an Atlanta coroner confirmed.

In June, Kensley's parents brought her to Family Medical Clinic in Atlanta, Ga. after she fell. When doctors administered the local anesthesia lidocaine while setting Kensley's arm, her parents "went from picking the color of the cast with their daughter to basically being with her as she died," Pete Law, the Kirby family's attorney, told ABC News' Atlanta local affiliate, WSB-TV.

A hospital spokesperson refused to comment on the case, and the family's attorney did not return several requests for comment.

"Dying from a local anesthesia is extremely rare," said Dr. Elliot Krane, professor of pediatrics and anesthesia at Stanford University. "But there is a maximum allowable dose of lidocaine, and as with any drug, it has toxicity associations with it."

Lidocaine is a common local anesthesia used topically to relieve itching and burning from skin irritations; it is injected during dental work and other minor surgeries. The drug blocks nerves and in turn, numbs pain, during surgical procedures.

Allergic reactions to the drug are rare, but excessive doses of the anesthesia can cause unconsciousness, seizures, low blood pressure and even cardiac arrest. Drug dosage is determined by a patient's weight and whether it will be injected into tissue mass or directly into the bloodstream.

"If they're getting it intravenously, the maximum dose is much smaller," said Krane.

It is unclear which way Kensley received the anesthesia after breaking her arm.

"It's possible that the doctor might have been accustomed to taking care of adults all the time, which would have been a larger dose than necessary," said Krane, who was quick to note that he did not know the details of the case. "And with broken bones, there's an opening of vascular channels, so it's possible that it absorbed very rapidly into the bloodstream."

If parents are concerned, Dr. Mark Singleton, chair of the committee of pediatric anesthesia at the American Society of Anesthesiologists, encouraged them to speak with their child's anesthesiologist prior to surgery to discuss their child's medical history and the type of anesthesia that will be administered. Krane also noted that doctors have been collecting information on anesthesia cases across the country over the past five years in a database known as the Pediatric Regional Anesthesia Network.

"It's our sense that nerve blocks are extremely safe," said Krane. "Complications are extraordinarily low."

"Parents should be aware that local anesthetics can be toxic," said Singleton. "This applies to the dental office, as well as other surgeries. It is important to recognize that anesthesiologists take very special precautions to minimize the complications of toxicity from local anesthetics."

Members don't see this ad.
 
i feel like there is more to this story, and there are probably other meds involved, possible allergic reaction.

I just don't get this. Atlanta is home to two of the best children's hospitals in the country. Together they have urgent care centers all around the metropolitan area. Why would you think a neighborhood doc in the box is an appropriate place to take care of a kid's fracture?

The article is short on details - no idea if it was a block or an IV regional or even just a bunch of local infiltration. No idea if any sedation was given. No idea what kind of doc was at the center, but clearly they weren't prepared to handle the complications of whatever it was that they did. Just like the death of the teenager from MH in an ASC a couple years ago that didn't have dantrolene on hand - senseless and unnecessary.
 
Members don't see this ad :)
I just don't get this. Atlanta is home to two of the best children's hospitals in the country. Together they have urgent care centers all around the metropolitan area. Why would you think a neighborhood doc in the box is an appropriate place to take care of a kid's fracture?

The article is short on details - no idea if it was a block or an IV regional or even just a bunch of local infiltration. No idea if any sedation was given. No idea what kind of doc was at the center, but clearly they weren't prepared to handle the complications of whatever it was that they did. Just like the death of the teenager from MH in an ASC a couple years ago that didn't have dantrolene on hand - senseless and unnecessary.

From what I gather, its not unreasonable to have ASCs that pool dantrolene supplies...i think that case was more failure to recognize than inability to treat.
 
honestly i cant understand what they would be using lidocaine for, unless they were trying to do IV regional/Bier block, which I would not be excited about doing in that setting
 
but died from a lethal dose of local anesthesia given to her at the clinic, an Atlanta coroner confirmed.
I wonder what they were up to, if this is indeed true. Could they have been doing a block on a kid? Why? Perhaps a Bier block? Were they reducing a fracture?

The whole thing is hard to comprehend. I would be devastated if I were involved.
 
They probably did a hematoma block and got uptake into the marrow, or injected a vessel. Compound that with likely way too much lido, a delay in acting/detecting, not knowing what to do, no intralipid, etc. The kid didn't have a chance. Sad. If you break your arm would you go to your FP? Odd choice.
 
They probably did a hematoma block and got uptake into the marrow, or injected a vessel. Compound that with likely way too much lido, a delay in acting/detecting, not knowing what to do, no intralipid, etc. The kid didn't have a chance. Sad. If you break your arm would you go to your FP? Odd choice.

Learn something everyday.

Yep, the lido probably went all iv.
 
I had a 5 year old going into VT once the surgeon gave him a penile block for circumcision. Luckily he converted back to sinus before we had to shock him, it might have been the epinephrine effect but we used intralipid after the event as a prophylactic measure. No adverse outcome the kid went home.
 
I had a 5 year old going into VT once the surgeon gave him a penile block for circumcision. Luckily he converted back to sinus before we had to shock him, it might have been the epinephrine effect but we used intralipid after the event as a prophylactic measure. No adverse outcome the kid went home.

5 year old? Did he have a phimosis? Just wondering why the parents decided at 5 to do a circ. I knew a guy my freshman year that had a circ done the summer before college. No medical reason, he just wanted to have it done. :eek:

To the OP: horrible story, scary stuff... as a father, I can't imagine it.
 
I had a 5 year old going into VT once the surgeon gave him a penile block for circumcision. Luckily he converted back to sinus before we had to shock him, it might have been the epinephrine effect but we used intralipid after the event as a prophylactic measure. No adverse outcome the kid went home.

I don't think a urologist would use epi on a dorsal penile nerve block.
Wouldn't want to compromise circulation and have something turn black and fall off...
 
Hematoma block is only good if used in the acute setting (i.e. <24hrs). Had an orthopod tell me that his pt. with a clavicle fracture (3 places) for ORIF didn't need an interscalene block. He said he would do an intraop block (hematoma block). Problem was the pt. was 5 days out from his fx. Opiod naive and writhing in pain in PACU after 4mg of dilaudid. Did a quick interscalene and he was comfy and asleep in 5 minutes. Pt. is an attending in another specialty at our place and still talks about how great regional is for pain control. He requested a block when he came back for exploration for non-union.
 
The hematoma block is a good block. I used it as an intern. (on adults)
5 min and you're good to go for realignment and casting.

I've done it in the hand for boxer's fracture with relatively low volume. You essentially need to fill the fresh hematoma, or get local in the fracture side.. You can do it in the arm? That seems like you would need a ton of local. Maybe that was the problem.
 
Top