An 83-year-old man (158 cm, 42 kg) was scheduled for
cholecystectomy. He had a history of
hypertension and
atrial fibrillation. The patient received no
premedication. An epidural
catheter was inserted via the T9-10 interspace and 2%
mepivacaine 7 ml was injected, producing a sensory block from T4 to T12.
Anesthesia was induced with
propofol and
remifentanil, and was maintained with
propofol,
remifentanil, and
nitrous oxide in
oxygen.
Rocuronium was given to provide neuromuscular block. Just before the completion of surgery, a bolus
epidural injection of 2%
mepivacaine 2 ml with
fentanyl 50 microg was performed. Then epidural
solution of
ropivacaine 0.1% with
fentanyl 6.25 microg x ml(-1), and
droperidol 25 microg x ml(-1) was infused at 4 ml x hr(-1). Soon after the surgery, the patient developed
atrial fibrillation that was treated with external electrocardioversion with 100 watt x sec. After the restoration of sinus rhythm,
anesthetics were discontinued. The patient did not emerge from
anesthesia though he breathed spontaneously
Doxapram was slightly effective, but he did not respond to the verbal command. Epidural infusion was stopped and the patient was transferred to the ward. The patient fully recovered from
anesthesia after 2 hours. Epidural infusion was restarted 17 hours later, and the patient fell asleep. He woke up after stopping epidural infusion. Epidurally administered
fentanyl must have been the cause of
delayed recovery from anesthesia. He could have been highly sensitive to
fentanyl. Patient controlled
epidural anesthesia may have been useful for this patient.