title: Recurrence of cardiotoxicity after lipid rescue from bupivacaine-induced cardiac arrest.
abstract: Accidental intravascular administration of bupivacaine during performance of a brachial block precipitated convulsions followed by asystole. The patient was rapidly resuscitated using cardiopulmonary resuscitation, supplemented by 150 mL of 20% lipid emulsion. Nonetheless, cardiac toxicity reappeared 40 min after completion of the lipid emulsion. In the absence of further lipid emulsion, amiodarone and inotropic support were used to treat cardiotoxicity. This case suggests that local anesthetic systemic toxicity may recur after initial lipid rescue. Since recurrence of toxicity may necessitate administration of additional doses of lipid emulsion, a sufficient quantity of lipid emulsion should be available when regional anesthesia is performed.
authors.affiliation: Department of Anesthesiology and Critical Care, University of Stellenbosch and Tygerberg Academic Hospital, Tygerberg, South Africa.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Marwick
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Levin
authors.forename: Andre R
authors.initials: AR
authors.lastname: Coetzee
mesh_terms: D000328:Adult; D000638:Amiodarone / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001917:Brachial Plexus; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D016887:Cardiopulmonary Resuscitation; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement; D005217:Fat Emulsions, Intravenous / Q000600:supply & distribution / Q000627:therapeutic use*; D005597:Fractures, Open / Q000601:surgery; D006323:Heart Arrest / Q000139:chemically induced / Q000628:therapy*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery; D007275:Injections, Intravenous; D008297:Male; D009407:Nerve Block / Q000009:adverse effects*; D012008:Recurrence; D012640:Seizures / Q000139:chemically induced / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000889:Anti-Arrhythmia Agents; D002316:Cardiotonic Agents; D005217:Fat Emulsions, Intravenous; D000638:Amiodarone; D002045:Bupivacaine