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[Transient complete left bundle branch block during epidural anesthesia with mepivacaine]
1Department of Anesthesia, Kobe West Municipal Hospital, Japan.
Masui. the Japanese Journal of Anesthesiology
|April 1, 1996
Summary
Mepivacaine epidural anesthesia can induce complete left bundle branch block (CLBBB) in patients with ovarian tumors, especially during tachycardia. This cardiac conduction abnormality resolves with heart rate reduction.
Area of Science:
- Cardiology
- Anesthesiology
- Cardiac Electrophysiology
Background:
- A 65-year-old woman with an ovarian tumor was scheduled for surgery under epidural anesthesia.
- Preoperative evaluations, including ECG, showed no abnormalities.
Observation:
- Twenty minutes after mepivacaine epidural injection, widened QRS complexes indicative of complete left bundle branch block (CLBBB) appeared with a heart rate of 150 bpm.
- CLBBB resolved when the heart rate decreased to 110 bpm with medication.
- CLBBB recurred upon repeat epidural anesthesia with mepivacaine, resolving as heart rate decreased with general anesthesia induction.
Findings:
- Mepivacaine administration during epidural anesthesia was associated with the transient development of CLBBB in this patient.
- The occurrence of CLBBB correlated with a higher heart rate and appeared to be influenced by the local anesthetic's effect on cardiac conduction.
- The effective refractory period (ERP) of the left bundle branch may be prolonged by mepivacaine, particularly under conditions of increased heart rate.
Implications:
- This case highlights a potential adverse cardiac event associated with mepivacaine epidural anesthesia, specifically CLBBB.
- Understanding the electrophysiological effects of local anesthetics on the cardiac conduction system is crucial for patient safety during anesthesia.
- Further research may be warranted to elucidate the precise mechanisms and patient factors contributing to mepivacaine-induced CLBBB.