Reactions 1112 - 29 Jul 2006

SBupivacaine

Seizures, and heart arrest treated with soya oilemulsion: case report

A 58-year-old man experienced heart arrest after localanaesthesia with bupivacaine for arthroscopic surgery on hisshoulder. He was successfully resuscitated afteradministration of soya oil emulsion.

The man, who had a history of coronary bypass and anginapectoris upon exertion, received 0.5% bupivacaine 20mL andmepivacaine in 5mL increments over approximately2.5 minutes. About 30 seconds after the block needle wasremoved, he turned incoherent and then developed a tonic-clonic seizure.

The man was given supplemental oxygen and IV propofol.The seizure stopped, and spontaneous respiration startedagain. Seizing resumed after about 90 seconds, and in spite ofadditional propofol injection, the ECG showed a heart arrestand no pulse or BP were detectable. Advanced cardiac lifesupport was started immediately, during which epinephrine[adrenaline], atropine, amiodarone, vasopressin andmonophasic defibrillation were administered, but mostarrhythmias observed were pulseless ventricular tachycardiaand asystole. After 20 minutes, infusion of 20% soya oilemulsion [Intralipid] 100mL, with cardiac compressions and adefibrillation shock, evoked a single sinus beat within seconds;cardiac compressions were continued. With subsequentatropine and epinephrine administration, a sinus rhythmreturned within 15 seconds; BP and pulse became detectable.An infusion of soya oil emulsion at 0.5 mL/kg/min wasmaintained for 2 hours. Mechanical ventilation and intubationwere stopped about 2.5 hours later. He was awake andresponsive, and monitored overnight. Cardiac catheterisationshowed total right coronary artery occlusion and a leftventricular ejection fraction of 32%. He was discharged afterthe implantation of a cardiac defibrillator.

Author comment: "In addition to [bupivacaine’s] localanaesthetic effects, it is a potent depressant of electricalconduction, which predisposes the heart to reentry types ofarrhythmias."Rosenblatt MA, et al. Successful use of a 20% lipid emulsion to resuscitate apatient after a presumed bupivacaine-related cardiac arrest. Anesthesiology 105:217-218, No. 1, Jul 2006 - USA 801041630

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Reactions 29 Jul 2006 No. 11120114-9954/10/1112-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved