title: Arrhythmia associated with tetracaine in an extremely low birth weight premature infant.
abstract: Infants in NICUs undergo a variety of painful procedures. The management of pain has become an integral part of newborn infant care with the use of both systemic and topical agents to provide analgesia and anesthesia for procedural pain. Tetracaine and prilocaine-lidocaine are the 2 topical anesthetics most frequently used. Tetracaine belongs to an ester group of local anesthetics available as a topical 4% gel (Ametop, Smith and Nephew, Canada). The major side effects reported when using topical anesthetics are cutaneous reactions. There are no definite reports of systemic toxicity in the published literature. We present a recent case of an extremely low birth weight premature infant who developed a clinically significant arrhythmia after topical tetracaine was applied before the insertion of a peripherally inserted central catheter. The infant had no other identifiable cause for the resulting bradycardia that occurred only after Ametop was applied. The cardiac symptoms resolved with treatment. This case highlights a significant potential adverse event when using topical tetracaine.
authors.affiliation: Divisions of Neonatology and Cardiology, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Ontario, Canada.
authors.forename: Halima
authors.initials: H
authors.lastname: Maulidi
authors.forename: Carol
authors.initials: C
authors.lastname: McNair
authors.forename: Neil
authors.initials: N
authors.lastname: Seller
authors.forename: Joel
authors.initials: J
authors.lastname: Kirsh
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Bradley
authors.forename: Steven C
authors.initials: SC
authors.lastname: Greenway
authors.forename: Chris
authors.initials: C
authors.lastname: Tomlinson
mesh_terms: D000779:Anesthetics, Local / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects; D054537:Atrioventricular Block / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D001285:Atropine / Q000008:administration & dosage / Q000009:adverse effects; D001506:Beckwith-Wiedemann Syndrome / Q000175:diagnosis / Q000628:therapy*; D001724:Birth Weight; D001919:Bradycardia / Q000139:chemically induced / Q000188:drug therapy; D002037:Bundle-Branch Block / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D002405:Catheterization, Central Venous; D004562:Electrocardiography / Q000187:drug effects*; D005865:Gestational Age; D019983:Guideline Adherence; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012815:Signal Processing, Computer-Assisted; D013748:Tetracaine / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000779:Anesthetics, Local; D000889:Anti-Arrhythmia Agents; D013748:Tetracaine; D001285:Atropine