Recurrence of cardiotoxicity after lipid rescue from bupivacaine-induced cardiac arrest
Date
2009
Authors
Marwick P.C.
Levin A.I.
Coetzee A.R.
Journal Title
Journal ISSN
Volume Title
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Abstract
Accidental intravascular administration of bupivacaine during performance of a brachial block precipitated convulsions followed by asystole. The patient was rapidly resuscitated using cardiopulmonary resuscitation, supplemented by 150 mL of 20% lipid emulsion. Nonetheless, cardiac toxicity reappeared 40 min after completion of the lipid emulsion. In the absence of further lipid emulsion, amiodarone and inotropic support were used to treat cardiotoxicity. This case suggests that local anesthetic systemic toxicity may recur after initial lipid rescue. Since recurrence of toxicity may necessitate administration of additional doses of lipid emulsion, a sufficient quantity of lipid emulsion should be available when regional anesthesia is performed. © 2009 International Anesthesia Research Society.
Description
Keywords
adrenalin, amiodarone, bicarbonate, bupivacaine, creatine kinase, insulin, intralipid, isoflurane, lipid emulsion, midazolam, potassium, thiopental, troponin I, antiarrhythmic agent, cardiotonic agent, local anesthetic agent, adult, anamnesis, apnea, article, asystole, brachial plexus anesthesia, capnography, cardiotoxicity, case report, convulsion, creatine kinase blood level, drug withdrawal, dry eye, dry throat, endotracheal intubation, heart arrest, heart muscle injury, hospital discharge, human, inotropism, intensive care unit, loading drug dose, male, priority journal, recurrent disease, regional anesthesia, resuscitation, sinus tachycardia, tachycardia, brachial plexus, chemically induced disorder, debridement, humerus fracture, intravenous drug administration, multimodality cancer therapy, nerve block, open fracture, seizure, treatment outcome, Adult, Amiodarone, Anesthetics, Local, Anti-Arrhythmia Agents, Brachial Plexus, Bupivacaine, Cardiopulmonary Resuscitation, Cardiotonic Agents, Combined Modality Therapy, Debridement, Fat Emulsions, Intravenous, Fractures, Open, Heart Arrest, Humans, Humeral Fractures, Injections, Intravenous, Male, Nerve Block, Recurrence, Seizures, Treatment Outcome
Citation
Anesthesia and Analgesia
108
4
108
4