medigraphic.com

2005, Number 4

<< Back Next >>

Rev Mex Anest 2005; 28 (4)

Mobitz II AV block secondary to subarachnoid bupivacaine. Case report and review of the literature

Vargas-Trujillo C, Ángeles-de la Torre R, Molina-Méndez FJ, Rojas PE, Lespron RMC

Language: Spanish
References: 17
Page: 239-243
PDF size: 87.64 Kb.


ABSTRACT

Introduction: Bupivacaine has been clearly implicated as the cause of fatal ventricular arrhythmias, reduced myocardial contractility and cardiac output; decreased intracardiac conduction velocity; and sudden cardiovascular collapse. We report a case of cardiotoxic effects secondary to the administration of isobaric 0.5% subarachnoid bupivacaine. Case summary: A 79-year-old female patient with left knee arthrosis was scheduled for total knee arthroplasty. Hypertension had been diagnosed three years ago and was currently treated with metoprolol. An EKG showed sinus bradycardia. Cardiac risk: Goldman II, ASA III A. Anesthetic management: sensory and motor L2-L3 blockade with 2 ml 0.5% subarachnoid bupivacaine. Thirty minutes into surgery, sinus bradycardia developed, down to 35 beats per minute, with no response to atropine, and progressing to Mobitz II atrioventricular block. Isoproterenol 2 μg/min infusion was started, achieving normal heart beat and blood pressure. Then, a temporary transvenous ventricular pacemaker was installed, with hemodynamic stability for the rest of the surgical time. Conclusion: Cardiotoxicity due to local anesthetics is an uncommon but well documented complication of regional anesthesia. This case demonstrates the successful management of a patient who developed an atrioventricular block after a regional blockade with bupivacaine.


REFERENCES

  1. Simon L, Kariya N, Pelle-Lancien E, Mazoit J. Bupivacaine-induced QRS prolongation is enhanced by lidocaine and by phenytoin in rabbit hearts. Anesth Analg 2002:94:203-7.

  2. Aya A, de la Coussaye J, Robert E, Ripart J, Cuvillon P, Mazoit J, Jeannes P, Fabbro-Péray P, Eledjam J. Comparison of effects of racemic bupivacaine, levobupivacaine, and ropivacaine on ventricular conduction, refractoriness, and wavelength: an epicardial mapping study. Anesthesiology 2002;(3):641-650.

  3. Moggi L. Anestésicos locales Cirpe. Hospital de niños “Ricardo Gutiérrez” Buenos Aires, Argentina.

  4. Reiz S, Haggmark S, Johansson G, Nath S. Cardiotoxicity of ropivacaine-a new amide local anesthetic agent. Acta Anesthesiol Scand 1989;33:93-95.

  5. Moller R, Covino B, Cardiac electrophysiologic effects of lidocaine and bupivacaine Anesth Analg 1988:67,107-14.

  6. Laudau R, Giraud R, Delrue V, Kern C. Unusual presentation of long QT syndrome. Br J Anesth 2003;90:804-7.

  7. Morrison S, Domínguez J, Frascarolo P, Reiz S. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine and ropivacaine in anesthetized swine. Anest Analg 2000;90(6):1308-1314.

  8. Redin J, Resano A. Complicaciones de la anestesia locorregional. Anales Sis San Navarra 1999;22,S2:85-91.

  9. Albright G. Cardiac arrest following regional anesthesia with etidocaina or bupivacaine. Anesthesiology 1979;51:285-7.

  10. Weinberg GL. Current concepts in resuscitation of patients with local anesthetic cardiac toxicity. Reg Anesth Pain Med 2002;27:568-575.

  11. Irvin W, Fontaine E, Agnolucci L, Penzo D, Betto R, Bortolotto S, Reggiani C, Salviati G, Bernardi P. Bupivacaine myotoxicity is mediated by mitochondria. J Biol Chen 2002;277(14):12221-7.

  12. Klein S, Pierce T, Rubin Y, Nielsen K, Steele S. Successful resuscitation after ropivacaine induced ventricular fibrillation. Anesth Analg 2003;97:901-3.

  13. Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology 1998;88:1071-75.

  14. Coronen A-M, Valanne JV, Jokela RM, Ravaska P, Korttila K. Intrathecal hyperbaric bupivacaine 3 mg+ fentanyl 10 µg for outpatient knee arthroscopy with tourniquet. Acta Anestehesiologica Scandinavica 2003,47:342-346.

  15. Huang YF, Prior ME, Mather LE, Veering BT. Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesth-Analg 1998;86(4):797-804.

  16. Santos AC, Arthur GR, Wlody D, De Armas P, Morishima HO, Finter M. Anesthesiology 1995;82(3):734-40.

  17. Soltesz EG, Pelt F, Byrne JG. Emergent cardiopulmonary bypass for bupivacaine cardiotoxicity. J Cardiothoracic and Vascular Anesthesia 2003;17(3):357-358.




2020     |     www.medigraphic.com