SUCCESSFUL RESUSCIТATION AND REHABILIТAТION OF А CHILD FROM ТНЕ STATE OF CLINICAL DEATH (CARDIAC ARREST), CAUSED ВУ NOVOCAIN INTOXICATION

Abstract

Cases of cardiac death (cardiac arrest) caused by local anesthesia with novocain аrе rarity. According tо Waters Jimms - 1944, clinical death accidents during lосаl anesthesia аrе encountered in 0,106%. They аrе mostly casually related to hypersensibility and intolerance to novocain. Exceedingly rаrе аrе the instances of cardiac arrest, caused bу novocain intoxication.

Recently, we had the possibility to observe resuscitation of а child from clinical death bу novocain intoxication, as well as its subsequent successful rehabilitation.

Оn 12 September, 1964 in the Naval Hospital at Varna, the patient N. J. J., 9-year-old schoolboy (c<.1se history 845•12. IX. 1963) ,vas ad111itted for tonsillectomy. Erroneousl.y, perito11sill><.1r aпesll1esi><.1 was carried out with 10% instead of 1 % novocai11 sollllion, lolalling а quantity of 40 111I. About 5 mi11 after the anesthesia the cl1ild sustains heavy epilept ifarrn fits \Vilh loss of consciousness. Breathing is gr><.1dually delayed, becomes superficial and in 1-2 miпutes it ceases completely. Several miПL1tes later heart­ ><.1ctivity is also arrestcd. Dil><.1tatio11 of the pupils is cstaЫishcd and rcaction to light disappears. The eyeballs аге softened. Full areflexia (аЬsепсе of reflexes) occurs. Epinephrine, luminal, caffeine, cardi><.1zol, plcgomaziп, nor-epinephriпe and cortisone аге adrninistered Ьу injcclio11. Оп the 4-5(11, miпule of cardiac arrest, the child is iпtubated, апd after fllrther 5 тjп, leftside thoracotomy апd direct heart massagc performed. Оп орепiпg ll1e chest cavity, the heart is fouпd relaxed iп diastole, filled up ,vilh Ыооd. The wound is not Ыeediпg. After пеагlу 40 compressioпs (pllmpiпg), independent cardiac activity is resumed. Blood pressLIГe is increased LIP to 120/80mm of Mercury columп, the pupils аге coпtracled. Pupillary reaction to light is restored. An hour later spoпtaneous breathing occurs, initially weaker апd superficial (28-30 respirations рег minute) апd subsequently, though speeded up - with adequate depth_and effectiveпess. T,venty fqur hours later extubation is resorted to and tracheostorny applied. The operative wouпd of the thorax heals Ьу first intention and no pulmonary comp lications occur.>ase history 845/12.IX.1963) was admitted  for tonsillectomy.  Erroneously, peritonsillar anesthesia was carried out with 10 % instead of 1 % Novocain solution, totaling a quantity of 40 ml. About 5 min, after the anesthesia the child sustains heavy epileptiform fits with loss of consciousness. Breathing is gradually delayed, becomes superficial and in 1-2 minutes it ceases completely. Several minutes later heart activity is also arrested. Dilatation of the pupils is established and reaction to light disappears. The eyeballs are softened. Full areflexia (absence of reflexes) occurs. Epinephrine, luminal, caffeine, cardiazol, plegomazin, nor-epinephrine and cortisone are administered by injection. On the 4-5^th minute of cardiac arrest, the child is intubated, and after further 5 min, leftside thoracotomy and direct heart massage performed. On opening the chest cavity, the heart is found relaxed in diastole, filled up with blood. The wound is not bleeding. After nearly 40 compressions (pumping), independent cardiac activity is resumed. Blood pressure is increased up to 120/80mm of Mercury column, the pupilis are contracted. Pupillary reaction to light is restored. An hour later spontaneous breathing occurs, initially weaker and superficial (28-30 respitations per minute) and subsequently, though speeded up – with adequate depth and effectiveness. Twenty four hours later extubations is resorted to and tracheostomy applied. The operative wound of the thorax heals by first intention and no pulmonary complications occur.