Reactions 1280 - 28 Nov 2009

SBupivacaine

Seizure and heart arrest: case reportA 47-year-old woman developed a seizure followed by

heart arrest after receiving bupivacaine during a leftshoulder arthroscopy.

The woman received 33mL of 0.5% bupivacaine for a leftscalene block through the interscalene groove and,3 minutes later, developed a seizure; she also hadhypertension, diabetes mellitus, depression anddyslipidaemia and was receiving enalapril, atorvastatin,metformin and fluoxetine.

The seizure was aborted with midazolam. The womanthen developed apnoea and was intubated. After 4 minutes,she developed asystole. Advance cardiac life supportprotocol was started and a spontaneous circulation wasachieved after 21 minutes following epinephrine[adrenaline] administration. A transoesophagealechocardiogram showed global hypokinesis and a leftventricular ejection fraction of 15%. After administration oflipid emulsion, her cardiac output showed improvement.Epinephrine infusion was then started and she wastransferred to an ICU. At this time, she had a BP of102/68mm Hg, a pulse rate of 95/min, a RR of 20/min, atemperature of 100.5°F and an oxygen saturation of 100%with a fraction of inspired oxygen of 100%. Laboratoryinvestigations revealed the following: creatinine level2.9 mg/dL, lactate level 15 mmol/L, arterial blood pH 7.17,carbon dioxide partial pressure 67mm Hg and oxygenpartial pressure 480mm Hg. An ECG showed sinus rhythmwith a new left axis deviation, an inverted T wave in theanterolateral leads and a prolonged QT interval. A chest x-ray showed a new pulmonary congestion. Vasopressorinfusion was stopped on hospital day 2 and repeatechocardiography showed a large area of apical kinesiswith an ejection fraction of 30%. Her acute renal injury andlactic acidosis rapidly resolved. On day 6, she wasextubated. She had a normal mental status with normalchamber sizes and function on echocardiography. She wassubsequently discharged on hospital day 12.Ogugua CS, et al. PREVENTION OF CATASTROPHIC OUTCOMES INSYSTEMIC BUPIVACAINE TOXICITY: EARLY RECOGNITION ANDAGGRESSIVE MANAGEMENT. 75th Annual Meeting of the American Collegeof Chest Physicians: Chest 2009 : 31 Oct 2009. Available from: URL: http://www.chestnet.org [abstract] - USA 803002433

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Reactions 28 Nov 2009 No. 12800114-9954/10/1280-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved