Reactions 1314 - 14 Aug 2010

SBupivacaine/lidocaine

Dizziness, seizure activity and heart arresttreated with lipid emulsion: case report

A 28-year-old man experienced dizziness, generalisedseizures with tonic-clonic activity and heart arrest afterreceiving lidocaine/bupivacaine during surgicalimplantation of a cardioverter defibrillator. He was treatedwith a lipid emulsion.

The man received a 50cc injection to the left subpectoralarea, which contained a combination of 2% lidocaineand 0.5% bupivacaine, corresponding to total dosesof 570mg and 107mg for lidocaine and bupivacaine,respectively. He developed dizziness after axillary venousaccess was achieved. Generalised seizures with intensetonic-clonic activity occurred several minutes later.

Midazolam and lorazepam were initiated in addition tosupportive ventilation. The man was subsequentlyintubated; pulseless electrical activity was observed andresuscitation was carried out. Epinephrine [adrenaline],vasopressin, atropine and saline were initiated.Bupivacaine toxicity was suspected, and two unitsof 20% lipid emulsion were infused. His pulse returned,and haemodynamic stability ensued. His surgery wasuneventfully performed 1 week later, without bupivacaine.

Author comment: "[W]e are confident the events weresecondary to local anesthetic toxicity due to the timing, theclinical presentation consistent with local anesthetic toxicity. . . this patient received a toxic dose of lidocaine plus a doseof bupivacaine approaching the upper limit."Gallagher C, et al. Lipid rescue for bupivacaine toxicity during cardiovascularprocedures. Heart International 5: 20-21, No. 1, 2010. Available from: URL: http://dx.doi.org/10.4081/hi.2010.e5 - USA 803028603

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Reactions 14 Aug 2010 No. 13140114-9954/10/1314-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved