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British Journal of Anaesthesia, 2000, Vol. 85, No. 4 632-634
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia

Complete recovery of consciousness in a patient with decorticate rigidity following cardiac arrest after thoracic epidural injection

K. Taga1,*, M. Tomita1, I. Watanabe2, K. Sato2, K. Awamori3, H. Fujihara1 and K. Shimoji1

1Department of Anaesthesiology, Niigata University School of Medicine, 1-757 Asahi-machi, Niigata951-8510, Japan. 2Intensive Care Unit, Niigata University School of Medicine, 1-757 Asahi-machi, Niigata 951-8510, Japan. 3Department of Neurology, Niigata University School of Medicine, 1-757 Asahi-machi, Niigata 951-8510, Japan

A 46-yr-old man with dysaesthesia (burning sensation) following herpes zoster in the left upper chest region was treated with a single thoracic (T2/T3) epidural injection (1.0% lidocaine 3 ml+0.125% bupivacaine 3 ml) as an outpatient. Twenty minutes after the injection, a nurse noticed the patient to be unconscious with dilated pupils, apnoea and cardiac arrest. Following immediate cardiopulmonary resuscitation, the patient was treated with an i.v. infusion of thiamylal sodium 2–4 mg kg–1 h–1 and his lungs were mechanically ventilated. When the patient developed a characteristic decorticate posture, mild hypothermia (oesophageal temperature, 33–34°C) was induced. On the 17th day of this treatment, after rewarming (35.5°C) and discontinuation of the barbiturate, the patient responded to command. Weaning from the ventilator was successful on the 18th day. About 4 months after the incident, the patient was discharged with no apparent mental or motor disturbances. We suggest that mild hypothermia with barbiturate therapy may have contributed to the successful outcome in this case. Br J Anaesth 2000; 85: 632–4

* Corresponding author


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