LipidRescue™ Resuscitation

84 year old female undergoing femoral nerve block using ultrasound prior to TKR.
Hx of IHD and EF 45%. No Hx of fitting, Weight 85kg, renal function OK, no unusual drugs. About 3 minutes after installation of block (23 mls of Ropivicaine 0.75%), negative aspiration , good spread around nerve noted, patient had generalized fit, immediately given intralipid as per Assoc Anesthetists guidelines, in conjunction with CPR for cardiogenic shock with bradycardia (already in preop AF with LBBB).
Resuscitated and 2 minutes CPR then inotrope infusion for 4 hours whist on ventilator in ICU, then extubated and discharged 2 days later, not to return (hopefully).
No AMI, no neurological deficit (gross), functioning FNB at 12 hours after.
Took 2 hourly TG levels asd well as Ropivicaine levls at 2 hours , trytase neg.
Presumably a small dose intravascular in a vulnerable patient, but assume a success for intralipid

Thanks for the post, John.
Can you elaborate a bit on the time course and extent of cardiovascular toxicity and its apparent reversal? How low did the heart rate go? The BP? Was there ever a non-perfusing rhythm (VT, VF)? Did you see a temporal correlation between lipid infusion and recovery of VS? What was teh total lipid dose?
Thanks
Guy

Fitting was first observable event. With fitting onset given Intralipid 200 mls then followed by rest of bottle.Shortly after fit noted cardiovascular toxicity effects. (arterial line in situ prior to onset of block).
The time course of the cardiovascular toxicity was about 2 minutes from completion of the block.
The cardiovascular toxicity featrues were hypotension associated with extreme bradycardia responsive to Atropine and Adrenaline.
There was good BP with CPR, no VF VT.
Vital signs responded within 7 minutes of CPR starting (aiding passage of intralipid I guess)
Tyrptase levels negative,
Ropivicaine levels taken at 1 hour and 4 hours (1.51ug/ml and 0.93ug/ml).
Total intralipid dose 1 bottle as reasonable resolution of cardiovascular profile.
As an addit, the patient has recovered fully and in fact has no back or knee pain therefore no current need for TKR operation. An unusual cure!!