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Cardiovascular collapse from low dose bupivacaine
Marc E Levsky1, Michael A Miller
1Department of Emergency Medicine, Darnall Army Community Hospital, Ft. Hood, Texas, USA.
Summary
Bupivacaine, a common anesthetic, can cause severe heart problems even at lower doses. This case highlights cardiac arrest from a dose below the previously known toxic threshold, emphasizing careful administration.
Area of Science:
- Anesthesiology
- Cardiology
- Pharmacology
Background:
- Bupivacaine is a widely used long-acting local anesthetic for various procedures.
- Known cardiotoxic effects include dysrhythmias, hypotension, and reduced cardiac output.
- The previously established minimum toxic intravenous dose in humans is 1.6 mg/kg.
Observation:
- A case of bradyasystolic arrest with post-resuscitation shock is reported.
- This occurred in an adult following bupivacaine injection.
- Notably, significant central nervous system (CNS) toxicity was absent.
Findings:
- The administered bupivacaine dose was less than 1.1 mg/kg.
- This dose is below the previously recognized minimum toxic threshold.
- The patient experienced severe cardiac events without CNS toxicity.
Implications:
- This case suggests that cardiotoxicity from bupivacaine may occur at lower doses than previously thought.
- It underscores the importance of careful dose monitoring and patient assessment during bupivacaine administration.
- Further research may be warranted to refine understanding of bupivacaine's toxicity profile.