Abstract
Local anesthetic-associated cardiac toxicity following caudal epidural blockade is, fortunately, a rare event. Prompt recognition and early treatment is the key to successful resuscitation. Early use of the lipid emulsion Intralipid in bupivacaine-induced cardiac toxicity may lead to a good outcome.
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Giaufre E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a 1 year prospective study of the French-Language Society of Pediatric Anesthesiologists. Anesth Analg. 1996;83:904–912.
Tobias JD, Caudal epidural block: a review of test dosing and recognition of systemic injection in children. Anesth Analg. 2001;93:1156–1161.
Prentiss JE. Cardiac arrest following caudal anesthesia. Anesthesiology. 1979;50:51–53.
Schweitzer SA. Avoiding intravascular injections during epidural anesthesia. Anesthesiology. 1980;53:81.
Baum VC. Caudal epidural block: a review of test dosing and recognition of systemic injection in children. Survey of Anesthesiology. 2002;46:156–157.
Tsui, Ban CH, Berde, Charles B. Caudal analgesia and anesthesia techniques in children. Curr Opin Anaesthesiol. 2005;18:283–288.
Clarkson CW, Hondeghem LM. Mechanism for bupivacaine depression of cardiac conduction: fast block of sodium channels during the action potential with slow recovery from block during diastole. Anesthesiology. 1985;62:396–405.
Mio Y, Fukuda N, Kusakari Y, Tanifuji Y, Kurihara S. Bupivacaine attenuates contractility by decreasing sensitivity of myofilaments to Ca2+, in rat ventricular muscle. Anesthesiology. 2002;97:1168–1177.
Mazoit JX, Denson DD, Samii K. Pharmacokinetics of bupivacaine following caudal anesthesia in infants. Anesthesiology. 1988;68:387–391.
Uejima T, Suresh S. Is 0.375% bupivacaine safe in caudal anesthesia in neonates and young infants? Anesth Analg. 2002;94:1041.
Lee BB, Ngan Kee WD, Plummer JL, Karmakar MK, Wong AS. The effect of the addition of epinephrine on early systemic absorption of epidural ropivacaine in humans. Anesth Analg. 2002;95:1402–1407.
Ngan Kee WD, Khaw KS, Lee BB, Wong EL, Liu JY. The limitations of ropivacaine with epinephrine as an epidural test dose in parturients. Anesth Analg. 2001;92:1529–1531.
Tanaka M, Nitta R, Nishikawa T. Increased T-wave amplitude after accidental intravascular injection of lidocaine plus bupivacaine without epinephrine in sevoflurane-anesthetized child. Anesth Analg. 2001;92:915–917.
Gussow L. IFE as antidote: the next big thing? Emergency Medicine News. 2008;30:8–9.
Brull SJ. Lipid emulsion for the treatment of local anesthetic toxicity: patient safety implications. Anesth Analg. 2008;106:1337–1339.
Weinberg GL, Ripper R, Murphy P, Edelman LB, Hoffman W, Strichartz G, Feinstein DL. Lipid infusion accelerates removal of bupivacaine and recovery from bupivacaine toxicity in the isolated rat heart. Reg Anesth Pain Med. 2006;31:296–303.
Stehr SN, Ziegeler JC, Pexa A, Oertel R, Deussen A, Koch T, Hubler M. The effects of lipid infusion on myocardial function and bioenergetics in l-bupivacaine toxicity in the isolated rat heart. Anesth Analg. 2007;104:186–192.
Wildsmith JAW. Treatment of local anaesthetic toxicity. Anaesthesia. 2008,63:778–789.
Weinberg G. Lipid rescue: caveats and recommendations for the “silver bullet” (letter). Reg Anesth Pain Med. 2004;29:74–75.
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Shah, S., Gopalakrishnan, S., Apuya, J. et al. Use of Intralipid in an infant with impending cardiovascular collapse due to local anesthetic toxicity. J Anesth 23, 439–441 (2009). https://doi.org/10.1007/s00540-009-0754-3
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DOI: https://doi.org/10.1007/s00540-009-0754-3