Reactions 988 - 14 Feb 2004

SRopivacaine

Heart arrest in an elderly patient: case reportA 66-year-old woman experienced heart arrest following

regional anaesthesia with ropivacaine during hallux valgussurgery.

The woman received an injection of 0.75% ropivacaine25mL into her tibial nerve following local anaesthesia withlidocaine; she had also received hydroxyzine and midazolamprior to surgery. Thirty minutes later her saphenous nerve wasinfiltrated subcutaneously with 0.75% ropivacaine 5mL, hertibial nerve was injected with 0.75% ropivacaine 4mL and hersuperficial and deep peroneal nerves with 0.75% ropivacaine6mL; she received a total ropivacaine dose of 300mg. Onehour later she became agitated and confused, lostconsciousness and developed oculogyric movements.

The woman was treated with IV midazolam and maskventilation was started. She had bradycardia (HR< 50 beats/min) and a BP of 90/60mm Hg. Her bradycardiaworsened (HR 30 beats/min) despite treatment with ephedrineand atropine, and her QRS complex became larger andprogressed to asystolic heart arrest. Cardiac massage wasstarted and she received an ephedrine injection. Thirtyseconds later effective cardiac and respiratory activitiesreappeared and sinus tachycardia rhythm was recorded. After70 minutes her plasma glucose, electrolyte and troponin levelswere normal; her plasma ropivacaine concentration was1.88 mg/L. Following surgery, completed under regionalanaesthesia, she had no awareness of the episode andexperienced no sequelae.

Author comment: "The absence of a neurologic or cardiachistory, the time profile, and the symptoms observed suggesta ropivacaine-induced toxic accident."Chazalon P, et al. Ropivacaine-induced cardiac arrest after peripheral nerve block:successful resuscitation. Anesthesiology 99: 1449-1451, No. 6, Dec 2003 -France 800970071

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Reactions 14 Feb 2004 No. 9880114-9954/10/0988-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved