Reactions 1199 - 26 Apr 2008

SBupivacaine

Heart arrest and tonic-clonic seizures in an elderlypatient: case report

An 83-year-old man experienced heart arrest and tonic-clonic seizures following administration of bupivacaine.

The man presented for a total knee arthroplasty (TKA) undergeneral anaesthesia with continuous femoral and single-injection sciatic nerve blocks for management of postoperativepain. He received midazolam and fentanyl for sedation. Healso received sciatic nerve block with a 5mL test dose of 0.5%bupivacaine and epinephrine [adrenaline] without any adverseevents. He then received an injection of 0.5% bupivacaine,epinephrine and clonidine. After injection of 26mL, he lostconsciousness and had a tonic-clonic seizure.

The injection was stopped and the man was placed in asupine position and given facemask ventilation. He receivedmidazolam. After his seizure had resolved, an ECG revealedheart arrest and he did not have a pulse. He underwent chestcompression and intubation. He received lipid emulsion,epinephrine and atropine. After 2 minutes, the ECG showedirregular wide-complex tachycardia, which became regularwithin 2 minutes. He then developed regular narrow-complextachycardia followed eventually by sinus rhythm. He wastransferred to an ICU in a stable condition. Within 90 minutes,he was awake and responsive. Six weeks later, he underwentTKA without any complications.Smith HM, et al. Simulation education in anesthesia training: a case report ofsuccessful resuscitation of bupivacaine-induced cardiac arrest linked to recentsimulation training. Anesthesia and Analgesia 106: 1581-1584, No. 5, May 2008 -USA 801080641

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Reactions 26 Apr 2008 No. 11990114-9954/10/1199-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved