Reactions 1192 - 8 Mar 2008

SBupivacaine

Tonic clonic seizures, and heart arrest treated withsoya oil emulsion in an elderly patient: case report

An 82-year-old woman developed tonic clonic seizures andheart arrest following administration of bupivacaine. She wassuccessfully resuscitated after administration of soya oilemulsion [Intralipid].

The woman, who had a history of well-controlledhypertension and hyperlipidaemia, was scheduled for totalright knee arthroplasty. She received IV midazolam andfentanyl and supplemental oxygen. Following cathetersecuring, she received ropivacaine and epinephrine[adrenaline]. She then received 30mL of 0.5% bupivacainewith epinephrine, administered in increments of 5mL, withnegative aspiration prior to each injection. About 20 secondsafter needle removal, she experienced a generalised tonicclonic seizure.

The woman received midazolam and was turned supine.After another 30 seconds, her seizure stopped and the oxygenfacemask was replaced by a self-inflating bag with increasedoxygen. After about 60 seconds, she had a second seizure,which spontaneously resolved. Her ECG revealed ventriculartachycardia (200 beats/min). She was unresponsive withspontaneous breathing. Defibrillation pads were placed andshe received IV amiodarone. She received 100mL of 20%Intralipid, over 60 seconds and, at this time, her ventriculartachycardia persisted. Her femoral pulse then diminished andshe received a synchronised countershock and her sinusrhythm immediately normalised. She received an additionalinfusion of 400mL of Intralipid over 15 minutes. From thispoint, her BP, rhythm and HR remained stable. She wasobtunded and, over the following hour, she washaemodynamically stable and became more responsive andalert. Two hours later, her mental condition was completelynormal. She was observed overnight in an ICU. Three daysafter this event, she elected to undergo knee replacementunder regional anaesthesia.McCutchen T, et al. Early intralipid therapy may have prevented bupivacaine-associated cardiac arrest. Regional Anesthesia and Pain Medicine 33: 178-180, No.2, Mar-Apr 2008 - USA 801103135

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Reactions 8 Mar 2008 No. 11920114-9954/10/1192-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved