LipidRescue™ Resuscitation

20% lipid emulsion for rescue from drug toxicity

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A Review of Lipid Resuscitation

Post Your Cases > local anesthetic cardiotoxicity in a 16yo with a tonsillar abcess

After Incision and drainage of a tonsillar abcess in a 16 yo male, an appropriate dose per kg of bupivacaine with epi was injected in to the site. The surgeon had apirated without evidence of an intravascular injection but within 30sec of injection, the patient had bradycardia into the 20's and a new bundle branch block. At times the p waves disappeared. The patient was given 3ml of 20% lipid emulsion, it was a 80kg muscular fit athlete. The preop heart rate was in the low 50's. Prior to giving the intralipid the heart rate would change from NSR to severe bradycardia and back to NSR repeatedly. Within 30seconds after giving the intralipid the heart rate increased and returned to a NSR without a BBB. The patient was extubated and taken to recover. The patient had one more very brief episode of bradycardia to the 40s with a BBB and then returned to normal spontaneously in the recovery room. No infusion was started because vital signs were stable for the next 2 hours. He was sent to the floor on telemetry and had a normal recovery otherwise.

September 2, 2010 |

Renee Koltes-Edwards

Thanks, Renee for posting this very interesting case. It brings up several points of interest. First, I've noted some papers in the ENT and dental literature advocating the use of buupivacaine in particular for tonsil or tonsilar pillar surgery. I cannot advocate for that practice given that many of these practitioners are unaware of the special dangers that go with using this drug..particularly in a highly vascular area. Second, given that pre-existing heart was probably not an issue in this young patient, I wonder if he falls into the category of 'highly susceptible' patients, those with a much lower than normal threshold for developing LA toxicity. We might also encourage the surgeon to co-author a case report with you in his specialty journal: we're still trying to get the word out to these physicians of the potential danger of LA toxicity and the fact that there is a new treatment.

September 27, 2010 |

[Guy Weinberg]