title: Severe bradycardia and bradypnea following vaginal oocyte retrieval: a possible toxic effect of paracervical mepivacaine.
abstract: We report a case of a patient with a history of heart conduction disease, symptom-free and without treatment in the last years, who experienced a severe cardiac complication associated with in vitro fertilization (IVF) with vaginal oocyte retrieval (VOR). Eighty-five minutes after the VOR a severe bradycardia and bradypnea occurred, requiring an emergency application of a pacemaker. Presumably the condition occurred because of a toxic effect of the 400 mg of mepivacaine administered paracervically. It is concluded that in the paracervical anesthesia in the IVF cycles the therapeutic range should be scrupulously followed in patients with heart condition.
authors.affiliation: Department of Obstetrics and Gynecology, Hospital of Cruces, Baracaldo, Vizcaya, País Vasco University, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Ayestaran
authors.forename: R
authors.initials: R
authors.lastname: Matorras
authors.forename: S
authors.initials: S
authors.lastname: Gomez
authors.forename: D
authors.initials: D
authors.lastname: Arce
authors.forename: F
authors.initials: F
authors.lastname: Rodriguez-Escudero
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D001919:Bradycardia / Q000139:chemically induced*; D004417:Dyspnea / Q000139:chemically induced* / Q000628:therapy; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects* / Q000379:methods; D006327:Heart Block / Q000150:complications; D006801:Humans; D008619:Mepivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D009865:Oocytes; D014621:Vagina
chemical_list: D000779:Anesthetics, Local; D008619:Mepivacaine