Reactions 1325 - 30 Oct 2010

SBupivacaine

Cardiotoxicity following epidural administrationin a neonate: case report

A 2-day-old boy developed cardiotoxicity followingepidural bupivacaine administration under generalanaesthesia for urologic surgery.

The boy received atropine for intubation. Followingintubation, he received oxygen, sevoflurane, andcisatracurium besilate. He subsequently received a caudalblock with 0.25% bupivacaine 0.1 mL/kg, injectedincrementally over 90s. During the injection, no superficialswelling was observed. However, within minutes, hedeveloped ST-segment elevation and widened QRScomplexes; these quickly progressed to multifocalpremature ventricular contractions. His heart ratedecreased to 70 bpm. Pulse oximetry showed poorperfusion. He experienced runs of ventricular tachycardia.

Sevoflurane was discontinued and the boy continued toreceive 100% oxygen. He received chest compressions andsoya oil emulsion. His haemodynamics and ECG readingsreturned to baseline over the following 3 minutes. Heremained stable. Anaesthesia was restarted and his surgerycommenced 25 minutes later. He was given fentanyl. Hewas extubated in the operating room at the end of theprocedure. He was discharged the following day, afterovernight observation, without sequelae.

Author comment: "Our case demonstrates the successfuluse of lipid rescue in a neonate with bupivacaine-inducedcardiotoxicity."Lin EP, et al. Successful resuscitation of bupivacaine-induced cardiotoxicity in aneonate. Pediatric Anesthesia 20: 955-957, No. 10, Oct 2010. Available from:URL: http://dx.doi.org/10.1111/j.1460-9592.2010.03406.x - USA 803042819

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Reactions 30 Oct 2010 No. 13250114-9954/10/1325-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved