Open AccessRecurrence of Cardiotoxicity After Lipid Rescue from Bupivacaine-Induced Cardiac Arrest
Author(s) -
Peter C Marwick,
Andrew Levin,
André Coetzee
Publication year - 2009
Publication title -
anesthesia and analgesia/anesthesia and analgesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.404
H-Index - 201
eISSN - 1526-7598
pISSN - 0003-2999
DOI - 10.1213/ane.0b013e3181979e17
Subject(s) - medicine , cardiotoxicity , lipid emulsion , toxicity , asystole , anesthesia , bupivacaine , local anesthetic , emulsion , resuscitation , cardiac toxicity , cardiopulmonary resuscitation , fat emulsion , pharmacology , surgery , parenteral nutrition , chemical engineering , engineering
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.