Reactions 1182 - 15 Dec 2007

SLevobupivacaine

Heart arrest: case reportA 45-year-old woman received an interscalene block with an

injection of 30mL of 0.25% levobupivacaine followed bygeneral anaesthesia prior to shoulder arthroscopy. She wasplaced in the beach-chair position. Within 15 minutes of thestart of surgery, she developed asystolic heart arrest. After5 minutes of CPR, she was revived. She required inotropicsupport in an ICU. Echocardiography revealed gross global leftventricular dysfunction, a poorly contracting septum andlateral wall and rest of left ventricle akinetic with minimalmitral regurgitation. A coronary angiogram revealed global leftventricular dysfunction with an ejection fraction of 20%. Twodays later, she was extubated and repeat echocardiographyrevealed normal left ventricular function.

Author comment: "Cardiac arrest in this patient couldhave been due to the activation of Bezold Jarish’s reflex andrelated vaso-vagal attack or to venous air embolism in sittingposition or to local anaesthetic toxicity or to anaphylaxis."Venkatesan PS, et al. Unusual sequelae following cardiac arrest during shoulderarthroscopy. Regional Anesthesia and Pain Medicine 32 (Spec. issue 1): 130 abstr.282, No. 5, Sep-Oct 2007 [abstract] - England 801095032

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Reactions 15 Dec 2007 No. 11820114-9954/10/1182-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved