Reactions 1186 - 26 Jan 2008

SRopivacaine

Heart arrest following epidural administration in apatient with aorta inflammation: case report

A 39-year-old woman, who had a history of aortainflammation, developed a sudden heart arrest afterundergoing epidural anaesthesia with ropivacaine during anelective caesarean.

The woman, whose medical history also includedpulmonary and aortic insufficiency, underwent an electivecaesarean on week 38 of pregnancy due to maternalcomplications; she had received prednisolone and aspirinthroughout her pregnancy. Epidural anaesthesia wasperformed with an injection of 20mL of 1% ropivacaine intothe third and fourth lumbar vertebrae. She developed aconvulsive seizure and chest discomfort 13 minutes after theinjection. At 14 and 17 minutes, pulseless ventriculartachycardia developed.

Sinus rhythm was restored at 14 minutes by a pericardialthump, and at 17 minutes by ephedrine. At 22 minutes afterropivacaine, the woman developed another pulselessventricular tachycardia resulting in heart arrest. She wasimmediately defibrillated with 200J; the caesarean section wasstarted simultaneously and a healthy baby was deliveredwithin 30 secs; the baby was delivered 8 minutes and30 seconds after the first pulseless ventricular tachycardia. Thewoman was resuscitated and had successful recovery of sinusrhythm. Her serial ropivacaine blood concentration was3.62 µg/mL. Both mother and child were discharged 11 daysafter the birth.

Author comment: "[T]oxicity of ropivacaine is believed tohave been the cause of cardiac arrest in this case."Yoshida M, et al. Sudden cardiac arrest during cesarean section due to epiduralanaesthesia using ropivacaine: a case report. Archives of Gynecology andObstetrics 277: 91-94, No. 1, Jan 2008 - Japan 801079712

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Reactions 26 Jan 2008 No. 11860114-9954/10/1186-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved