title: Bupivacaine-induced myocardial depression and pulmonary edema: a case report.
abstract: Central nervous system and cardiovascular toxicity are well-known side effects of bupivacaine. We report a case of bupivacaine-induced myocardial depression and cardiogenic pulmonary edema. A previously healthy woman developed soon after bupivacaine epidural injection of 5 mL 0.5% (25 mg) cardiogenic shock complicated with pulmonary edema. There were pronounced rales on auscultation with a butterfly sign on chest radiograph. A cardiac ultrasound showed reduced myocardial contractility, diffuse hypokinesia, left ventricular ejection fraction (LVEF) 25%, mitral and pulmonary insufficiency. Right heart catheterization showed increased pulmonary artery wedge pressure (34 mm Hg) and a pulmonary artery pressure of 48 over 33 mm Hg. These findings suggest myocardial depression owing to bupivacaine sodium channel blocking of myocardial nerve and tissue and subsequent reduction of myocardial contractility. The patient completely recovered with normalization of clinical, roentenographic, ultrasound, and hemodynamic findings and discharged 10 days later in good condition.
authors.affiliation: 401 General Army Hospital of Athens, Cardiology Department, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Cotileas
authors.forename: P
authors.initials: P
authors.lastname: Myrianthefs
authors.forename: A
authors.initials: A
authors.lastname: Haralambakis
authors.forename: P
authors.initials: P
authors.lastname: Cotsopoulos
authors.forename: C
authors.initials: C
authors.lastname: Stamatopoulou
authors.forename: C
authors.initials: C
authors.lastname: Ladakis
authors.forename: G
authors.initials: G
authors.lastname: Baltopoulos
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000009:adverse effects*; D002045:Bupivacaine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D011654:Pulmonary Edema / Q000139:chemically induced*; D012770:Shock, Cardiogenic / Q000139:chemically induced*
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine