title: Successful reversal of bupivacaine and lidocaine-induced severe junctional bradycardia by lipid emulsion following infraclavicular brachial plexus block in a uremic patient.
abstract: Cardiac toxicity of bupivacaine has long been documented and it could be potentiated in certain circumstances, such as preexisting cardiac conduction abnormality or uremic status. The concept that lipid emulsion acts as a rescue of bupivacaine's toxicity has prevailed pending universal recognition. Herein, we report the successful use of lipid to resuscitate a female uremic patient who sustained junctional bradycardia while she was receiving ultrasound-guided infraclavicular brachial plexus block with the dose of local anesthetics far below the currently recommended maximum one. The possible mechanisms for the occurrence of cardiotoxicity in this case are discussed and the role of lipid emulsion as a treatment is reviewed.
authors: Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC. yhshih1982@vghks.gov.tw
authors: Yu-Hsuan
authors: YH
authors: Shih
authors: Chen-Hsiu
authors: CH
authors: Chen
authors: Ying-Ming
authors: YM
authors: Wang
authors: Kang
authors: K
authors: Liu
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000009:adverse effects*; D001917:Brachial Plexus; D001919:Bradycardia / Q000139:chemically induced* / Q000628:therapy; D002045:Bupivacaine / Q000009:adverse effects*; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects*; D009407:Nerve Block; D014511:Uremia / Q000150:complications*
chemical_list: D000779:Anesthetics, Local; D005217:Fat Emulsions, Intravenous; D008012:Lidocaine; D002045:Bupivacaine