Hypercarbia Induced Severe Bronchospasm and Unconsciousness Following Supraclavicular Block

Case Report

Austin J Anesthesia and Analgesia. 2016; 4(2): 1050.

Hypercarbia Induced Severe Bronchospasm and Unconsciousness Following Supraclavicular Block

Ajmal PM, Shahla Haleem*, Varun K Varshney, Abhishek Singh and Amrin Badar

Department of Anaesthesiology, Faculty of Medicine, J N Medical College, AMU, Aligarh, UP, India

*Corresponding author: Shahla Haleem, Department of Anesthesiology & Critical Care J N Medical College, AMU, Aligarh, UP, India

Received: November 29, 2016; Accepted: December 09, 2016; Published: December 12, 2016

Abstract

Though the popularity of brachial plexus block for upper limb surgery is well known fact, but, one must not forget the complications associated with it. Herein, we report a middle aged obese female with fracture olecranon and proximal end of radius was posted for tension band wiring of olecranon process under ultrasound guided supraclavicular brachial plexus block. She was a known case of chronic obstructive pulmonary disease (COPD), with severe lung fibrosis and collapse, pleural thickening and mediastinal shift to the same side where she had to be operated. After repeated referral for optimization to tuberculosis and respiratory diseases she was posted for surgery after explaining the high risk involved to the patient. Following completion of procedure, she turned supine from lateral decubitus position, found unconscious and tachypnoeic. On auscultation, there was severe bronchospasm/silent chest; was immediately intubated and managed with difficulty.

Keywords: Supraclavicular brachial block; Unconsciousness following supraclavicular block; Severe Bronchospasm / silent chest

Introduction

Brachial plexus block under ultrasound guidance is considered as safe and dependable technique with high success rate and minimal or no complication. In spite the popularity of brachial plexus nerve blocks and its several advantages including providing effective analgesia, reducing narcotic requirements and facilitating ambulatory care surgery; one must not forget their impact on chest wall mechanics, tidal volume, PaO2 levels the unwanted effects of phrenic nerve palsy, if associated with central obesity.

Phrenic nerve paralysis/paresis is common and known complication associated with inter scalene brachial plexus block where the incidence is 90-100% [1-3]. In supraclavicular approach the incidence of phrenic nerve block is also reported as 40% to 60% [4,5], but often ignored, as the phrenic or cervical sympathetic nerve block (Horner’s syndrome) not create problem clinically and neuropathy usually requires reassurance only [4].

In the present case report successful supraclavicular brachial plexus block, was complicated by unconsciousness and respiratory distress at the end of procedure. On auscultation she had severe bronchospasm with minimal air entry/silent chest, was intubated and managed with difficulty.

Case Presentation

50 years old obese female (body mass index of 29.2kg/m²), with past history of tuberculosis was presented with injury to right elbow, chest and rib fracture, following fall in the bathroom. On General examination pulse: 72/min; B.P: 122/72mmHg; Respiratory rate: 22/ min. Trachea shifted to right side, bilateral rhonchi with additional fine crepitations were present on right side with decreased air entry on auscultation. Laboratory investigations showed leucocytosis and other investigations were within normal limits; Chest X Ray showed opacity in right upper and mid zones suggestive of granulomatous lesion with lung fibrosis with mediastinal shift to fracture side (Figure 1).

Citation: Ajmal PM, Haleem S, Varshney VK, Singh A and Badar A. Hypercarbia Induced Severe Bronchospasm and Unconsciousness Following Supraclavicular Block. Austin J Anesthesia and Analgesia. 2016; 4(2): 1050. ISSN: 2381-893X