LipidRescue™ Resuscitation

This case happened several months ago and involved an elderly gentleman with a history of CAD and ischemic cardiomyopathy presenting for total knee arthroplasty. A femoral block was performed with 30 mls 0.25% bupivacaine with epinephrine. There was no blood on aspiration, however it was noted later that the medication was injected very fast. Almost immediately after the block the patient started having generalized seizures followed by cardiac arrest. After less than a minute of chest compressions a heart rhythm reappeared but the patient was bradycardic and hypotensive despite administartion of vasopressors. The decision was made to administer Intralipid 20%. 1 bottle was administered as a bolus (about 10 mins after the onset of the toxicity) which improved the hemodynamic status and allowed the discontinuation of vasoactive drugs. The patient's mental status returned to baseline. No further intralipid was given and the patient had uneventful surgery (without block) several days later.