Emergence agitation after intraoperative neurolytic celiac plexus block with alcohol: a case report

Abstract Background Emergence agitation after general anesthesia may cause several undesirable events in the clinic during patient anesthesia recovery, and acute alcohol intoxication, while rare in surgery, is one of the risk factors. Case presentation A 66-year-old male patient was found to have pa...

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Main Authors: Huixuan Zhou, Yinbing Pan, Cunming Liu, Xiaodi Sun
Format: Article
Language:English
Published: BMC 2021-08-01
Series:BMC Anesthesiology
Subjects:
Online Access:https://doi.org/10.1186/s12871-021-01426-2
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spelling doaj-8f3700fd8e5542cab714e0c45962f18b2021-08-22T11:13:37ZengBMCBMC Anesthesiology1471-22532021-08-012111310.1186/s12871-021-01426-2Emergence agitation after intraoperative neurolytic celiac plexus block with alcohol: a case reportHuixuan Zhou0Yinbing Pan1Cunming Liu2Xiaodi Sun3Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical UniversityDepartment of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical UniversityDepartment of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical UniversityDepartment of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical UniversityAbstract Background Emergence agitation after general anesthesia may cause several undesirable events in the clinic during patient anesthesia recovery, and acute alcohol intoxication, while rare in surgery, is one of the risk factors. Case presentation A 66-year-old male patient was found to have pancreatic tail neoplasm upon computed tomography (CT) examination. The surgeon planned to resect the pancreatic tail under general anesthesia. However, the surgeon found extensive tumor metastasis in the abdominal cavity, and thus performed a neurolytic celiac plexus block (NCPB) with 40 ml 95% ethyl alcohol and finished the surgery in approximately 1 h. Twenty minutes later, the patient was extubated and developed significant emergence agitation in the postoperative care unit, characterized by restlessness, uncontrollable movements, confusion and disorientation. The patient was flushed and febrile with an alcohol smell in his breath and was unable to follow commands. Patient symptoms were suspected to be due to acute alcohol intoxication. Thus, the patient was given 40 mg of propofol intravenously. Following treatment, the patient recovered with less confusion and disorientation after approximately 10 min. After treatment with propofol twice more, he regained consciousness, was calm and cooperative, had no pain, and could obey instructions approximately 1 h and 40 min following the last treatment. Following this treatment, the patient was transferred to the inpatient ward and felt well. Conclusions It is paramount to correctly identify the underlying cause of emergence agitation in order to successfully manage patient symptoms, since treatment plans vary between different etiological causes. Emergence agitation may be due to acute alcohol intoxication after intraoperative use of alcohol.https://doi.org/10.1186/s12871-021-01426-2Emergence agitationNeurolytic celiac plexus blockPropofolAcute alcohol intoxicationCase report
collection DOAJ
language English
format Article
sources DOAJ
author Huixuan Zhou
Yinbing Pan
Cunming Liu
Xiaodi Sun
spellingShingle Huixuan Zhou
Yinbing Pan
Cunming Liu
Xiaodi Sun
Emergence agitation after intraoperative neurolytic celiac plexus block with alcohol: a case report
BMC Anesthesiology
Emergence agitation
Neurolytic celiac plexus block
Propofol
Acute alcohol intoxication
Case report
author_facet Huixuan Zhou
Yinbing Pan
Cunming Liu
Xiaodi Sun
author_sort Huixuan Zhou
title Emergence agitation after intraoperative neurolytic celiac plexus block with alcohol: a case report
title_short Emergence agitation after intraoperative neurolytic celiac plexus block with alcohol: a case report
title_full Emergence agitation after intraoperative neurolytic celiac plexus block with alcohol: a case report
title_fullStr Emergence agitation after intraoperative neurolytic celiac plexus block with alcohol: a case report
title_full_unstemmed Emergence agitation after intraoperative neurolytic celiac plexus block with alcohol: a case report
title_sort emergence agitation after intraoperative neurolytic celiac plexus block with alcohol: a case report
publisher BMC
series BMC Anesthesiology
issn 1471-2253
publishDate 2021-08-01
description Abstract Background Emergence agitation after general anesthesia may cause several undesirable events in the clinic during patient anesthesia recovery, and acute alcohol intoxication, while rare in surgery, is one of the risk factors. Case presentation A 66-year-old male patient was found to have pancreatic tail neoplasm upon computed tomography (CT) examination. The surgeon planned to resect the pancreatic tail under general anesthesia. However, the surgeon found extensive tumor metastasis in the abdominal cavity, and thus performed a neurolytic celiac plexus block (NCPB) with 40 ml 95% ethyl alcohol and finished the surgery in approximately 1 h. Twenty minutes later, the patient was extubated and developed significant emergence agitation in the postoperative care unit, characterized by restlessness, uncontrollable movements, confusion and disorientation. The patient was flushed and febrile with an alcohol smell in his breath and was unable to follow commands. Patient symptoms were suspected to be due to acute alcohol intoxication. Thus, the patient was given 40 mg of propofol intravenously. Following treatment, the patient recovered with less confusion and disorientation after approximately 10 min. After treatment with propofol twice more, he regained consciousness, was calm and cooperative, had no pain, and could obey instructions approximately 1 h and 40 min following the last treatment. Following this treatment, the patient was transferred to the inpatient ward and felt well. Conclusions It is paramount to correctly identify the underlying cause of emergence agitation in order to successfully manage patient symptoms, since treatment plans vary between different etiological causes. Emergence agitation may be due to acute alcohol intoxication after intraoperative use of alcohol.
topic Emergence agitation
Neurolytic celiac plexus block
Propofol
Acute alcohol intoxication
Case report
url https://doi.org/10.1186/s12871-021-01426-2
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