Cardiac Arrest after Local Anaesthetic Toxicity in a Paediatric Patient

We report a case of a paediatric patient undergoing urological procedure in which a possible inadvertent intravascular or intraosseous injection of bupivacaine with adrenaline in usual doses caused subsequent cardiac arrest, completely reversed after administration of 20% intravenous lipid emulsion. Early diagnosis of local anaesthetics toxicity and adequate cardiovascular resuscitation manoeuvres contribute to the favourable outcome.

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An In Vitro Analysis of the Effects of Intravenous Lipid Emulsion on Free and Total Local Anaesthetic Concentrations in Human Blood and Plasma

Critical Care Research and Practice ◽

10.1155/2014/236520 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7

Author(s):

Louise Ann Clark ◽

Jochen Beyer ◽

Andis Graudins

Keyword(s):

Blood Plasma ◽

Human Blood ◽

Local Anaesthetic ◽

Whole Blood ◽

Lipid Emulsion ◽

Equilibrium Dialysis ◽

Human Blood Plasma ◽

Intravenous Lipid Emulsion ◽

Vitro Effect

Background. Intravenous lipid emulsion (ILE) is recommended as a “rescue” treatment for local anaesthetic (LA) toxicity. A purported mechanism of action suggests that lipophilic LAs are sequestered into an intravascular “lipid-sink,” thus reducing free drug concentration. There is limited data available correlating the effects of ILE on LAs.Aims. To compare the in vitro effect of ILE on LA concentrations in human blood/plasma and to correlate this reduction to LA lipophilicity.Method. One of four LAs (bupivacaine-most lipophilic-4 mg/L, ropivacaine-6 mg/L, lignocaine-14 mg/L, and prilocaine-least lipophilic-7 mg/L) was spiked into plasma or whole blood. ILE or control-buffer was added. Plasma was centrifuged to separate ILE and total-LA concentration assayed from the lipid-free fraction. Whole blood underwent equilibrium dialysis and free-LA concentration was measured. Percent reduction in LA concentration from control was compared between the LAs and correlated with lipophilicity.Results. ILE caused a significant reduction in total and free bupivacaine concentration compared with the other LAs. Ropivacaine had the least reduction in concentration, despite a lipophilicity similar to bupivacaine. The reduction in LA concentration correlated to increasing lipophilicity when ropivacaine was excluded from analysis.Conclusion. In this first in vitro model assessing both free- and total-LA concentrations exposed to ILE in human blood/plasma, ILE effect was linearly correlated with increasing lipophilicity for all but ropivacaine.

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Use of an Intravascular Heat Exchange Catheter and Intravenous Lipid Emulsion for Hypothermic Cardiac Arrest After Cyclobenzaprine Overdose

Therapeutic Hypothermia and Temperature Management ◽

10.1089/ther.2015.0006 ◽

2015 ◽

Vol 5 (3) ◽

pp. 171-176 ◽

Cited By ~ 3

Author(s):

Michael S. Westrol ◽

Nadia I. Awad ◽

Patrick J. Bridgeman ◽

Erika Page ◽

Jonathan V. McCoy ◽

...

Keyword(s):

Cardiac Arrest ◽

Heat Exchange ◽

Lipid Emulsion ◽

Intravenous Lipid Emulsion ◽

Exchange Catheter

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Delayed-Onset Seizure and Cardiac Arrest After Amitriptyline Overdose, Treated With Intravenous Lipid Emulsion Therapy

PEDIATRICS ◽

10.1542/peds.2011-2511 ◽

2012 ◽

Vol 130 (2) ◽

pp. e432-e438 ◽

Cited By ~ 37

Author(s):

M. Levine ◽

D. E. Brooks ◽

A. Franken ◽

R. Graham

Keyword(s):

Cardiac Arrest ◽

Lipid Emulsion ◽

Onset Seizure ◽

Intravenous Lipid Emulsion ◽

Delayed Onset ◽

Amitriptyline Overdose

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1155: Cocaine Toxicity Producing Refractory Cardiac Arrest Managed With Intravenous Lipid Emulsion

Critical Care Medicine ◽

10.1097/01.ccm.0000730508.86785.d2 ◽

2020 ◽

Vol 49 (1) ◽

pp. 579-579

Author(s):

Christopher Shaw ◽

Bennett Lane ◽

James Makinen ◽

Adam Gottula ◽

Kyle Walsh ◽

...

Keyword(s):

Cardiac Arrest ◽

Lipid Emulsion ◽

Intravenous Lipid Emulsion ◽

Cocaine Toxicity ◽

Refractory Cardiac Arrest

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Resuscitation following a bupivacaine injection for a cervical paravertebral block

Open Medicine ◽

10.1515/med-2019-0112 ◽

2019 ◽

Vol 14 (1) ◽

pp. 953-958

Author(s):

Saulius Vosylius ◽

Valentinas Uvarovas ◽

Saulė Svediene ◽

Igoris Satkauskas

Keyword(s):

Local Anaesthetic ◽

Lipid Emulsion ◽

Subcutaneous Tissue ◽

Rare Event ◽

Kidney Injury ◽

Local Anaesthetics ◽

Adverse Outcomes ◽

Paravertebral Block ◽

University Hospital ◽

Chest Compressions

AbstractBackgroundCardiac arrest related to nerve blockade using a local anaesthetic is a rare event. We report a case of bupivacaine severe cardiovascular toxicity following cervical paravertebral nerve block.Case presentationA 44-year-old female was admitted to Republican Vilnius University Hospital, with symptoms of sustained severe pain in her neck that radiated to both arms. Multiple cervical intervertebral hernias with spinal stenosis were confirmed by magnetic resonance imaging. Following infiltration of the subcutaneous tissue with a 0.5 % bupivacaine solution, an 18-gauge spinal needle was used to perform the paravertebral block at the C6 level. Bupivacaine was injected in incremental doses to a total of 10 mL. Rapid loss of consciousness and cardiovascular collapse suggested a neuraxial injection of bupivacaine. Long-lasting cardiopulmonary resuscitation, including chest compressions, defibrillation attempts for refractory ventricular fibrillation, medications, mechanical ventilation, and intravenous lipid emulsion infusion, was successful. No severe adverse outcomes other than acute kidney injury and chest pain related to prolonged chest compressions were documented.ConclusionsThis case report emphasizes the necessity of ensuring adequate safety precautions to avoid local anaesthetic systemic toxicity. Lipid emulsion preparations should be available in all hospital settings where local anaesthetics are used for regional anaesthesia or pain management.

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