title: Cardiogenic shock associated with loco-regional anesthesia rescued with left ventricular assist device implantation.
abstract: A healthy 53 year old man developed profound cardiogenic shock following instillation of bupivacaine-lidocaine-epinephrine solution as a locoregional anesthetic for elective outpatient shoulder surgery. Intubation, resuscitation, and transfer to the nearby hospital were done: echocardiography showed profound biventricular dysfunction; cardiac catheterization showed normal coronary arteries. Despite placement of an intra-aortic balloon pump and intravenous vasoactive drugs, the patient remained in shock. Stabilization was achieved with emergent institution of cardiopulmonary bypass and placement of a temporary left ventricular assist device (LVAD). Twenty-four hours later, cardiac function normalized and the LVAD was removed. The patient was discharged five days later and remained with normal heart function in three-year follow-up.
authors.affiliation: Department of Cardiothoracic Surgery, Lankenau Hospital, Wynnewood, PA, USA. SamuelsLE@aol.com
authors.forename: Louis E
authors.initials: LE
authors.lastname: Samuels
authors.forename: Elena
authors.initials: E
authors.lastname: Casanova-Ghosh
authors.forename: Christopher
authors.initials: C
authors.lastname: Droogan
mesh_terms: D000765:Anesthesia, Conduction / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D001182:Arthroscopy; D002045:Bupivacaine / Q000009:adverse effects; D004837:Epinephrine / Q000009:adverse effects; D006353:Heart-Assist Devices; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000009:adverse effects
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D002045:Bupivacaine; D004837:Epinephrine