Reactions 1374 - 22 Oct 2011

SBupivacaine

Coronary artery spasm in an elderly patient: casereport

A 66-year-old man with lumbar discopathy developedsevere coronary artery spasm during treatment withbupivacaine.

The man received epidural 0.1% bupivacaine [dose notclearly stated] for his lower back pain and, 20 hours later,he experienced severe retrosternal chest pain. Physicalexamination revealed diaphoresis, a heart rate of 55bpmand a BP of 90/58mm Hg; 12-lead ECG showed abnormalST-segment elevations and depressions. He was moved toa cardiac care unit and experienced a second episode ofchest pain 2 hours later with similar ECG findings. He hadmild in-stent restenosis of the left anterior descendingartery, and severe diffuse narrowing of the right coronaryartery, apparent upon coronary angiogram.

The man was initially treated with sublingualnitroglycerin for his first episode of chest pain, with rapidresolution of his symptoms, and his epidural catheter wasremoved when he was admitted to cardiac care. His secondepisode of chest pain was treated with intracoronarynitroglycerin, which resulted in rapid resolution of vesselnarrowing. He then received IV nitroglycerin andlercanidipine; the nitroglycerin was subsequently replacedby isosorbide mononitrate. His recovery was uneventful.Mutlak M, et al. Severe coronary artery spasm induced by epidural injection ofbupivacaine hydrochloride: A case report. Acute Cardiac Care 13: 155-158, No. 3,Sep 2011. Available from: URL: http://dx.doi.org/10.3109/17482941.2011.567286- Israel 803061781

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Reactions 22 Oct 2011 No. 13740114-9954/10/1374-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved