Document Detail

Successful resuscitation of serious bupivacaine intoxication in a patient with pre-existing heart failure.
MedLine Citation:
PMID:  12514153     Owner:  NLM     Status:  MEDLINE    
PURPOSE: In dogs intoxicated with bupivacaine, clonidine is effective to treat conduction disturbances and dobutamine corrects myocardial depression. We report the case of a patient who experienced severe bupivacaine cardiotoxicity and who was treated successfully using these medications. CLINICAL FEATURES: In a patient with pre-existing heart failure a surgical procedure to fix a humeral fracture was necessary. Preoperatively, heart failure was controlled with transcutaneous nitroglycerin and iv deslanoside. A bupivacaine bolus was administered iv accidentally (a mixture of bupivacaine 75 mg, 15 micro g clonidine). The patient developed nodal rhythm with extreme bradycardia, severe shock and convulsions. Seizures were controlled with thiopentone/succinylcholine. Epinephrine iv boluses (0.1 mg x 3) restored blood pressure (BP) to 50/30 mmHg and heart rate (HR) to 60 (nodal rhythm). Following 75 micro g clonidine iv, BP rose to 90/70 and HR to 90 min. Cardiac rhythm reverted to sinus rhythm with first degree atrio-ventricular block. Echocardiography showed hyperkinesia and relative hypovolemia that was controlled with iv administration of terlipressin and glucagon. Subsequent dobutamine infusion stabilized hemodynamic conditions. It was decided to proceed with surgery using a midazolam/sufentanil based general anesthetic. In the intensive care unit, recovery, extubation and weaning from the dobutamine infusion were realized within 16 hr of the event. CONCLUSIONS: In this patient with preoperative heart failure, clonidine was effective to treat bupivacaine induced conduction disturbances. Epinephrine and dobutamine were effective to treat myocardial depression and terlipressin effectively controlled vasodilatation.
Jean-Christophe Favier; Manuel Da Conceiçao; Mikaïla Fassassi; Laurent Allanic; Thierry Steiner; Raphaël Pitti
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  50     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-01-06     Completed Date:  2003-12-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  62-6     Citation Subset:  IM    
Intensive Care Unit, Hôpital Legouest, Metz Armées, France.
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MeSH Terms
Adrenergic alpha-Agonists / therapeutic use*
Adrenergic beta-Agonists / therapeutic use*
Anesthetics, Local / adverse effects*
Bupivacaine / adverse effects*
Clonidine / therapeutic use*
Dobutamine / therapeutic use*
Heart Failure / complications*
Injections, Intravenous / adverse effects
Middle Aged
Reg. No./Substance:
0/Adrenergic alpha-Agonists; 0/Adrenergic beta-Agonists; 0/Anesthetics, Local; 2180-92-9/Bupivacaine; 34368-04-2/Dobutamine; 4205-90-7/Clonidine
Comment In:
Can J Anaesth. 2003 Dec;50(10):1077-8; author reply 1078   [PMID:  14656793 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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