Transient 7‐hour coma following a sacrococcygeal epidural with ropivacaine in a cat

Abstract A 2‐year‐old cat was anaesthetised for pelvic fracture repair. Premedication included methadone 0.2 mg/kg and medetomidine 5 µg/kg intravenously (IV). Anaesthesia was induced with ketamine 2 mg/kg and propofol 1 mg/kg IV and maintained with isoflurane. A sacrococcygeal epidural with ropivacaine 0.75% was performed with nerve stimulation: injection of 0.21 mL/kg initially, followed by 0.11 mL/kg after needle repositioning due to clear fluid extravasation pericatheter (total: 2.4 mg/kg). After 10 minutes, increased anaesthetic depth was noted with eye centralisation, no corneal reflex and bradycardia. Isoflurane was stopped. Atipamezole, naloxone and lipid emulsion 2 mL/kg over 1 minute twice followed by 0.25 mL/kg/min for 1 hour did not improve neurological status. An intracranial hypertension was suspected, treated with mannitol (total 2 g/kg). Metabolic acidosis and hyperkalaemia arose. After 7 hours of coma, neurological status improved. Full recovery was achieved within 12 hours. Re‐anaesthesia a week later without regional analgesia proceeded without complication.