Reactions 1338 - 12 Feb 2011

SBupivacaine

Hypotension and ventricular tachycardiafollowing inadvertent IV administration: casereport

A 13-year-old girl, who was about to undergo cleft lip andpalate repair, developed immediate circulatory arrest withhypotension and ventricular tachycardia followinginadvertent IV administration of bupivacaine.

General anaesthesia was induced with propofol, fentanyland isoflurane and then maintained with isoflurane. Fiveminutes after the endotracheal tube was secured, a nurseinadvertently administered 10mL of bupivacaine 0.25%intravenously (0.5 mg/kg) instead of an antibiotic. The girldeveloped a sinus tachycardia at a rate of 134 beats/minand her systolic BP decreased from 90 to 60mm Hg within90 sec.

Soya oil emulsion was administered and the girl receivednormal saline and IV boluses of epinephrine. Her BPimproved only transiently. She developed a slow heartrhythm with a broad QRS complex and ST segmentdepression that was immediately followed by a ventriculartachycardia. External chest compressions werecommenced. The ventricular tachycardia self-converted tosinus tachycardia. Her BP was 60/35mm Hg and dopamineand epinephrine infusions were administered. Followingstabilisation of her BP, she was transferred to an ICU.Pulmonary oedema developed 1 hour after the event andresolved over the following 2 days. The dopamine infusionwas tapered off and she was extubated 2 days after theevent. Four days after the event, she was discharged.Fuzaylov G, et al. Successful resuscitation after inadvertent intravenous injectionof bupivacaine in an adolescent. Pediatric Anesthesia 20: 958-9, No. 10, Oct 2010.Available from: URL: http://dx.doi.org/10.1111/j.1460-9592.2010.03404.x -USA 803049123

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Reactions 12 Feb 2011 No. 13380114-9954/10/1338-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved