Post Your Cases > Successful resuscitation of long cardiac arrest due to Lidocaine Toxicity by Lipid infusion.

Successful resuscitation of long cardiac arrest due to Lidocaine Toxicity by Lipid infusion.
What I write down here is not the case I did, nor the one I observed by myself. That case in fact was the communication between our colleagues on my facebook's fan page "regional anesthesia & pain management created" by myself, so the information would be not precisely as it happened

20 year old male presented to one rural hospital in the mountainous region of North Vietnam to repair a clavicular fracture. Regional anesthesia (the subclavicular brachial plexus block) was planned as routine approach in this hospital. 400 mg of plain lidocaine of 1% (40 ml) was prepared to be administered using anatomic landmark technique. The symptoms of local anesthetic systemic toxicity (LAST) happened right after a half dose of prepared lidocaine volume was finished: tinnitus, seizure and followed by cardiac arrest. The anesthetic team immediately did CPR (basic and advanced) to stabilize what they thought was "Anaphylactic Shock". The total amount of Epinephrine given for CPR was 70 mg in 30 minutes (including electric shocks which had been given twice), but all the resuscitative attempts were not successful. Fortunately, in this desperate situation one of the anesthesiologists remembered to infuse Lipid for LAST (that she learned from the regional anesthesia training course which we organized last year), so 500 ml of Lipid 20 % was infused rapidly. After a coup of minutes the cardiac rhythm was recovered and the patient’s life was saved.
LAST is very common in Vietnam due to a multitude of reasons for example, large dose of local anesthetics as unique approach to cover surgery, many anesthesia personnel without basic anesthesia training. Then LAST is usually wrong-diagnosed with anaphylactic reaction to LA and this leads to the possibly avoided severe consequences if detected and treated properly earlier. Even the anesthesiologists haven't update the role of Lipid infusion for treatment LAST. Some argues that lipid is not as effective in treating Lidocaine Toxicity as lipid soluble agents such as Bupivacaine.
Recently, there was a case of "Anaphylactic Shock" after lidocaine was given for tooth removal in a provincial hospital in the North of Vietnam (150 km from the capital of Hanoi). A large dose of epinephrine was given along with basic and advanced CPR without success of recovering the cardiac rhythm. The patient was transported to Emergency Center in Hanoi for Extra Corporeal Membrane Oxygenation ( ECMO). They are proud of the successful deflection of the nearly missed case. However, it would have been simpler and safer for the patient if she were properly diagnosed with LAST and given sooner.
August 5, 2017 | Unregistered CommenterNGUYEN ANH TUAN, M.D