Reactions 1289 - 20 Feb 2010

SBupivacaine

Heart arrest following inadvertent intravascularadministration: case report

A 17-year-old girl developed heart arrest followinginadvertent intravascular administration of bupivacaine.Subsequent treatment including lipid infusion wassuccessful.

The girl was to undergo ulnar shortening under axillaryblock. Transarterial axillary block was started using0.5% bupivacaine with 1:200 000 epinephrine [adrenaline],injected in incremental doses with negative aspiration.After 15cc had been injected, her heart rate abruptlyincreased to 180 beats/minute [duration of therapy toreaction onset not stated]. Blood was evident on aspirationsuggesting intravascular administration; she began seizing.

Midazolam and propofol were used to control the girl’sseizures, and her airway was immediately secured.Ventricular tachycardia rapidly followed, and her pulse wasnot palpable. She received acute cardiac support includingcardiopulmonary resuscitation and epinephrine. A 20%lipid infusion was also commenced. Followingadministration of the first bolus of 100mL lipid infusion, herECG changed from ventricular tachycardia to sinus rhythm.She received two additional bolus of lipid, and she becamehaemodynamically stable. She began continuous lipidinfusion, and her surgery was postponed. She wastransferred to an inpatient intensive care unit but wasdischarged home at 48 hours with no neurological deficit.

Author comment: "This article reports the successfulresuscitation of a hand surgery patient after inadvertentintravascular injection of bupivacaine during axillary block".Cordell CL, et al. Lipid Infusion Rescue for Bupivacaine-Induced Cardiac ArrestAfter Axillary Block. Journal of Hand Surgery - American Volume 35: 144-146,No. 1, Jan 2010. Available from: URL: http://dx.doi.org/10.1016/j.jhsa.2009.10.018- USA 803006203

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Reactions 20 Feb 2010 No. 12890114-9954/10/1289-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved