Reactions 854 - 2 Jun 2001

Bupivacaine/lidocaine

Arrhythmias in an infant: case reportA 2-month-old girl developed increased T-wave amplitude

after receiving lidocaine and bupivacaine for caudalanaesthesia in the absence of epinephrine [adrenaline]administration.

The infant, who was scheduled for hernia repair, wasanaesthetised with sevoflurane and nitrous oxide in oxygenwithout a premedication. Caudal administration of a mixture oflidocaine 1% and bupivacaine 0.25% was commenced in 1mlstages. 18 seconds after administering the third 1ml dose, amarked increase in T-wave amplitude of approximately 160%was seen in lead II of an ECG; this episode lasted until 35seconds postinjection. An aspiration test was positive forblood and administration of lidocaine and bupivacaine wasstopped. End-tidal sevoflurane concentration and CO2 tensionwere 1.5% and 30mm Hg, respectively. Her noninvasive BPand HR were 69/34mm Hg and 134 beats/min before, and67/33mm Hg and 136 beats/min after, caudal administration,respectively.

Surgery was commenced as the infant washaemodynamically stable. She was agitated on emergencefrom anaesthesia, with active movements of the upper andlower extremities, but her postoperative course was otherwiseuneventful.

Author comment: ‘This case report suggests that a change inT-wave morphology, which has been presumed to be a result ofIV epinephrine per se, may actually be a result of an IV localanaesthetic.’Tanaka M, et al. Increased T-wave amplitude after accidental intravascularinjection of lidocaine plus bupivacaine without epinephrine in sevoflurane-anesthetized child. Anesthesia and Analgesia 92: 915-917, Mar 2001 -Japan 800865367

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Reactions 2 Jun 2001 No. 8540114-9954/10/0854-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved