A 66-year-old man presented for repair of his torn right rotator cuff. His medical history was only remarkable for a 30-pack-year smoking history and chronic obstructive pulmonary disease. Preoperative pulmonary function testing showed a forced vital capacity (FVC) of 1.8 L (40% predicted). The surgeon called the anesthesiologist two days preoperatively to request regional anesthesia, in view of the patient’s pulmonary disease. The anesthesiologist administered an interscalene block with 30 mL 0.5% bupivacaine with epinephrine.
Approximately seven minutes after the interscalene injection, the patient became dyspneic and progressively cyanotic, requiring intubation. Attempts to wean and extubate the patient repeatedly failed. Only 12 hours after the interscalene block was the patient finally able to be extubated. What could have led to the respiratory failure? (Answer is posted in the…
