Reactions 1514, p37 - 16 Aug 2014

O SRopivacaine overdose

Local anaesthetic systemic toxicity leading tocardiac arrest: case report

A 25-year-old woman developed cardiac arrest followinglocal anaesthetic systemic toxicity (LAST); subsequent toropivacaine [not all routes stated] overdose administered byher anaesthesiologist and surgeon due to miscommunication.

The woman underwent laparoscopic gynaecologic surgeryunder general anaesthesia. At the end of her laparoscopy, shewas administered an intraperitoneal infiltration of 20mLropivacaine 0.75% by the surgeon without notifying heranaesthesiologist. Her trachea was extubated due tosignificant postoperative pain. Forty five minutes after theropivacaine peritoneal infiltration by her surgeon, shecomplained of severe pain. She was then administered withropivacaine 150mg (0.75%, 20mL) on each side as a bilateraltransversus abdominis plane (TAP) block by heranaesthesiologist. Ten minutes after the TAP block, sheexperienced a clonic seizure and her lungs were manuallyventilated with 100% O2 and she was treated with thiopental,and orotracheal intubation was performed. Two minutes later,she developed a severe bradycardia rapidly followed byasystole.

The woman was initiated on cardiopulmonary resuscitation.She was given a bolus of lipid emulsion 20% followed by acontinuous infusion, which resulted in a immediate restorationof her cardiac activity. She regained consciousness 15 minuteslater and showed no further signs of cardiac toxicity. She wasdischarged on the postoperative day 2 without physicalsequelae.

Author comment: "We describe, after obtaining patientconsent to publish the report, a case involving localanesthetic systemic toxicity (LAST) resulting in cardiac arrestdirectly related to a lack of communication between theanesthetic and surgical teams at the end of surgery."Scherrer V, et al. Cardiac arrest from local anesthetic toxicity after a field blockand transversus abdominis plane block: A consequence of miscommunicationbetween the anesthesiologist and surgeon. A and A Case Reports 1: 75-76, No. 5,01 Dec 2013. Available from: URL: http://doi.org/10.1097/ACC.0b013e3182973a3f - France 803107058

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Reactions 16 Aug 2014 No. 15140114-9954/14/1514-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved