Reactions 1516, p112 - 30 Aug 2014

SLevobupivacaine/lidocaine

Acute heart failure: 2 case reportsTwo women developed acute heart failure after

administration of levobupivacaine or lidocaine.A 58-year-old woman received levobupivacaine [dosage and

route not stated] as local anaesthetic for a shoulder surgery.After surgery, she received levobupivacaine as local infusionfor 3 more days to facilitate an early rehabilitation. She died ofpulmonary embolism [time to reaction onset not stated].Cardiac resuscitation attempt failed. Levobupivacaine assay atthe beginning of resuscitation showed 960 µg/L. Resuscitationwas prolonged for 8 hours but was ineffective.

A 69-year-old woman received lidocaine as local anaestheticduring a spinal surgery at 70mg (1 mg/kg) after anaesthesiainduction and then 1.3 mg/kg/h [route not stated]. She sufferedcardiac arrest 50 minutes after the surgery. Investigationsshowed lidocaine levels at 500 and 380 µg/L at 3 and 7 hoursafter cardiac arrest. Resuscitation was ineffective. She receivedepinephrine and other drugs; however, a prolonged electrical/mechanical dissociation persisted and resuscitation wasstopped after 9 hours. She subsequently died. Autopsyexamination failed to explain death.*

Author comment: "Two cases of sudden death withnontoxic level of [local anaesthetics] in blood and tissues."

* Reporter country was not stated.

Coquerel A, et al. Is there an underestimated toxicity of local anaesthetics (LA) asantalgics during or after surgery? Two cases of sudden death with nontoxic levelof LA in blood and tissues. Basic and Clinical Pharmacology and Toxicology 115(Suppl. 1): 73 abstr. 236, Jul 2014. Available from: URL: http://onlinelibrary.wiley.com/doi/10.1111/bcpt.12259_2/pdf [abstract] -Unknown 803107267

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Reactions 30 Aug 2014 No. 15160114-9954/14/1516-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved