Lipid resuscitation in a carnitine deficient child following intravascular migration of an epidural catheter.
A child with cerebral palsy and carnitine deficiency developed ventricular arrhythmias with loss of cardiac output during elective surgery under general anaesthesia with concomitant epidural analgesia. Sinus rhythm was restored on administration of adrenaline, but hypotension persisted despite resuscitation. Bolus administration of 0.8 ml*kg(-1) (20 ml) lipid emulsion resulted in rapid improvement in cardiac output. Blood samples taken before and after the lipid bolus did not demonstrate toxic concentrations of bupivacaine. This case suggests that carnitine deficiency may increase susceptibility to bupivacaine cardiotoxicity.
Department of Anesthaesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Ontario, Canada. gail.wong@sickkids.ca
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McDonnell
D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000295:instrumentation; D000779:Anesthetics, Local / Q000009:adverse effects*; D002045:Bupivacaine / Q000009:adverse effects*; D002331:Carnitine / Q000172:deficiency*; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D005548:Foreign-Body Migration / Q000150:complications; D006323:Heart Arrest / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced / Q000628:therapy; D008297:Male; D008508:Medication Errors / Q000009:adverse effects
D000779:Anesthetics, Local; D005217:Fat Emulsions, Intravenous; D002331:Carnitine; D002045:Bupivacaine