Reactions 967 - 6 Sep 2003

Bupivacaine

Brugada syndrome following epiduraladministration in an elderly patient: case report

A 77-year-old man developed a Brugada-type ECG patternwhile receiving epidural bupivacaine during an electivegastrectomy for stomach cancer.

The man initially received 10mL of bupivacaine 0.25% givenin 2mL increments over 5 minutes via an epidural catheter,followed by an infusion of bupivacaine 0.125% and fentanylcommenced at 8 mL/h. Anaesthesia was induced withmidazolam, propofol, fentanyl and rocuronium, thenmaintained with sevoflurane. After an uneventful 2 houroperation, he was transferred to recovery where he receivedan 8mL bolus of bupivacaine 0.125% and fentanyl. He alsoreceived IV colloid solution to maintain his systolic BP at100mm Hg. Prior to surgery, his BP had been 130/60mm Hgand an ECG had shown a partial right bundle branch block(RBBB). At 3 and 11 hours postoperatively, he received 5mLepidural boluses of bupivacaine 0.125% and fentanyl for painand, after the second bolus, his systolic BP decreased to 80mmHg. An ECG showed apparent RBBB with new coved STelevation in V1-V3. A provisional diagnosis of Brugadasyndrome, unmasked by the sodium blocking effects ofbupivacaine, was made and bupivacaine was replaced withepidural pethidine after a total infusion time of 17 hours (totalbupivacaine dose 442.5mg). His ECG changes subsided overthe following 48 hours and he recovered completely.Subsequent echocardiography findings were unremarkable.Phillips N, et al. Brugada-type electrocardiographic pattern induced by epiduralbupivacaine. Anesthesia and Analgesia 97: 264-267, Jul 2003 -Australia 800947547

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Reactions 6 Sep 2003 No. 9670114-9954/10/0967-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved