Reactions 952 - 24 May 2003

O SBupivacaine overdose

Seizures, bradycardia and shock followinginadvertent IV administration: case report

A 60-year-old woman with pre-existing heart failureinadvertently received IV bupivacaine and clonidine beforesurgery for fixation of a distal humerus fracture.

In the operating room, the woman received 75mg of 0.375%bupivacaine and 15µg clonidine injected IV over < 1 minute,instead of antibacterial prophylaxis. Immediately after theinjection, she had a seizure which lasted for approximately 20seconds, in addition to extreme bradycardia and anunmeasurable BP. After thiopentone administration theseizure stopped, and she was given succinylcholine andintubated and ventilated. Her HR and BP increased after IVepinephrine [adrenaline]. She was then treated with IVclonidine, terlipressin, glucagon and dobutamine and herhaemodynamic status stabilised.

It was decided to continue with surgery. The woman hadtwo episodes of polymorphous ventricular extrasystole duringsurgery, which were treated with IV magnesium sulphate andclonidine. After surgery, she was extubated and thedobutamine infusion was stopped within 16 hours. She wasdischarged from the ICU on day 3 and did not have anyneurological sequelae during follow-up.Favier J-C, et al. Successful resuscitation of serious bupivacaine intoxication in apatient with pre-existing heart failure. Canadian Journal of Anesthesia 50: 62-66,Jan 2003 - France 800933023

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Reactions 24 May 2003 No. 9520114-9954/10/0952-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved