LipidRescue™ Resuscitation

Within 2 minutes following iPACK (20 mls of 0.375% plain bupivacaine) & ACB (20 mls of 0.375% plain bupivacaine) for 69 year old male patient with history of hypertension, for right total knee arthroplasty, in whom spinal anaesthesia was administered prior to USG blocks, patient's heart rate dropped from 86 to 32 beats per minute, blood pressure with cuff was 55/36 mmHg, patient had new onset shoulder & facial twitches, and became unresponsive. Oxygen was administered by face mask and ventilation gently assisted with bag, inj. midazolam 1 mg given, inj. atropine 0.6 mg given iv, and 100 mls 20% lipolipid emusion rapidly infused over 3 minutes. Within 3 minutes, blood pressures improved, heart rate was 90 beats per minute, and patient began to respond and became alert and responsive. Arterial cannula was placed in right radial artery for direct pressure monitoring, supplemental oxygen administered, 12 lead ECG was done to rule out new changes, and, after 30 minutes of symptom free monitoring, surgeon was told to perform surgery. Patient is doing well in the immediate postoperative period.