Reactions 1194 - 22 Mar 2008

SBupivacaine/lidocaine

Heart arrest following epidural administration in apatient with nail-patella syndrome: case report

A 64-year-old man with nail-patella syndrome, mild renalimpairment and coronary artery disease underwent ahemicolectomy for colon cancer. Epidural anaesthesia for thisprocedure was induced by 2% lidocaine 60mg followed by0.5% bupivacaine 25mg; in addition, propofol, fentanyl,isoflurane and oxygen-enriched nitrous oxide wereadministered for general anaesthesia. During the perioperativeinsertion of a nasogastric tube, there was a sudden loss of hispulse oximetry [time to reaction onset not stated], end-tidalCO2 and arterial pressure waveforms, with an asystolicelectrocardiogram signal. He received atropine and normalsaline and, following an asystolic period of 20–30 seconds,myocardial activity resumed (110 beats/minute) with normalvital signs. There were no further sequelae.

Author comment: The heart arrest may have been causedby a vasovagal reflex during nasogastric tube placement,which could have been exaggerated by the neuraxial block,preoperative β-blocker treatment, and autonomic dysfunctiondue to nail-patella syndrome.Hennessey T, et al. Intraoperative asystole in a patient with nail-patella-syndrome.Canadian Journal of Anesthesia 54 (Suppl. 1): abstr. 43405, Jun 2007 -Canada 801105012

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Reactions 22 Mar 2008 No. 11940114-9954/10/1194-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved