Reactions 984 - 17 Jan 2004

SRopivacaine

Ventricular fibrillation in an elderly patient: casereport

Ventricular fibrillation occurred in a 76-year-old womanfollowing the administration of ropivacaine for anterior sciaticblock prior to foot osteotomy. She was also taking olanzapineand citalopram.

The woman was sedated and underwent a femoral blockwith mepivacaine. An anterior sciatic block was then achievedwith 0.5% ropivacaine. After receiving 32mL (160mg) ofropivacaine she became less responsive and the agent wasdiscontinued. Within 5–10 seconds she developed tachycardiaand experienced twitching of her face and hand. The twitchingrapidly progressed to a tonic-clonic seizure despite treatmentwith midazolam.

The woman was ventilated and her seizures were stoppedwith propofol. She remained unresponsive and was intubated.Her pulse rate slowed and within 3 minutes of the ropivacaineinjection ventricular fibrillation occurred. Chest compressionswere performed for 60 seconds. She then converted to sinusbradycardia and within a further minute she began to makerespiratory efforts. She was alert and breathing regularly10 minutes after the injection.

A venous blood sample taken 5 minutes after receivingropivacaine revealed a total plasma ropivacaine concentrationof 3.2 mg/L and a free plasma ropivacaine concentration of0.5 mg/L.

The woman’s surgery was completed and she wasdischarged from hospital the following day without furthercomplications.

Author comment: "The serum ropivacaine concentrationssuggest that a portion of the 160mg dose entered thecirculation contributing to the cardiac arrest." The womanwas also taking olanzapine and citalopram and these agents"may have increased the sensitivity to the arrhythmogeniceffects of ropivacaine".Klein SM, et al. Successful resuscitation after ropivacaine-induced ventricularfibrillation. Anesthesia and Analgesia 97: 901-903, No. 3, Sep 2003 -USA 800953592

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Reactions 17 Jan 2004 No. 9840114-9954/10/0984-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved