Ropivacaine-induced Cardiac Arrest after Peripheral Nerve Block: Successful Resuscitation

Chazalon, Pascal; Tourtier, Jean Pierre; Villevielle, Thierry; Giraud, Didier; Saissy, J. M.; Mion, G.; Benhamou, Dan

doi:10.1097/00000542-200312000-00030

Cited by 68 publications

(31 citation statements)

References 16 publications

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“…Several case reports of central nervous system symptoms and cardiovascular symptoms after the unintentional intravascular injection of ropivacaine in relation to upper extremity blocks [8][9][10] and lower extremity blocks [5][6][7][11][12][13] have been published. Interestingly, five cases occurred during an attempted sciatic nerve block.…”

Section: éLéments Cliniquesmentioning

confidence: 99%

“…[1][2][3] However, it is a potent local anesthetic and ropivacaine-induced convulsions, cardiac dysrhythmias and even cardiac arrests have been described after unintentional intravascular injection during peripheral nerve blocks. [5][6][7][8][9][10][11][12] In a recent case report by Klein et al successful resuscitation after ropivacaine-induced ventricular fibrillation was described where resuscitation measures were successful without defibrillation. 13 Defibrillation was planned, but with the use of oxygen, propofol, intubation and chest compression, the circulation returned before the defibrillator was ready to use.…”

mentioning

confidence: 99%

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Successful defibrillation immediately after the intravascular injection of ropivacaine

Gielen

Slappendel

Jack

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To report successful resuscitation of ventricular fibrillation induced by accidental intravascular injection of ropivacaine.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 15-yr-old healthy girl weighing 59 kg was scheduled for transposition of the tibial tuberosity under combined sciatic/three-in-one block. No premedication was given. In the induction room, an iv infusion was started, along with electrocardiogram monitoring, non-invasive blood-pressure measurement and pulse-oximetry. The sciatic nerve was found with the use of a nerve stimulator at the first attempt by the classical approach of Labat. Aspiration for blood was negative and the injection of ropivacaine 0.75% without epinephrine started. Convulsions, followed within seconds by ventricular fibrillation occurred at the end of the injection of 18 mL ropivacaine 0.75%. Oxygen was administered by face mask ventilation and immediate defibrillation was successful on the second attempt (2 × 200 joules). Within two minutes convulsions stopped and normal cardiac rhythm returned. Propofol and sufentanil were injected and a laryngeal mask inserted to start general anesthesia for surgery. Postoperatively no evidence of sciatic block could be demonstrated. The patient did not remember the event and was discharged the following day with no residual effects.

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Section: éLéments Cliniquesmentioning

confidence: 99%

mentioning

confidence: 99%

Successful defibrillation immediately after the intravascular injection of ropivacaine

Gielen

Slappendel

Jack

2005

Can J Anesth/J Can Anesth

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“…3 The incidence of ropivacaineinduced toxic events has been estimated as six to eight cases per 1,000,000 patients. A Chazalon et al 4 cited cases of severe toxicity associated with ropivacaine after regional anesthesia. As an update to the worldwide cumulative experience, the Table summarizes cases of ropivacaine toxicity during peripheral nerve blocks in adults reported since 2002.…”

Section: Discussionmentioning

confidence: 99%

Case report: Ropivacaine neurotoxicity at clinical doses in interscalene brachial plexus block

Dhir

Ganapathy

Lindsay

et al. 2007

Can J Anesth/J Can Anesth

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Purpose: To describe a case of ropivacaine toxicity following an ultrasound guided interscalene block and discuss the possible mechanisms involved. Clinical features:A 76-yr-old woman with multiple myeloma was scheduled for open reduction and internal fixation following a pathological fracture of her left upper humerus. She developed central nervous system toxicity with ropivacaine 15 min after a carefully placed ultrasound-guided interscalene catheter. The dose of ropivacaine was within recommended limits and there was no evidence that the catheter was intravascular. Surgery proceeded uneventfully under general anesthesia. The interscalene catheter was left in situ for postoperative evaluation and intravascular injection was ruled out with a colour Doppler study. The total ropivacaine plasma concentration was 3.68 µg·mL -1 . Neurological evaluation, contrast computerized tomography and electroencephalogram were normal. The patient was discharged home with no sequelae. Advanced age, malnutrition, epinephrine and possible elevation of α-1 -acid glycoprotein levels could have altered the pharmacokinetics of plasma ropivacaine and possibly contributed to delayed neurotoxicity. Conclusions:Local anesthetic toxicity is an uncommon but well documented complication of regional anesthesia. Careful monitoring and preparedness for managing complications during the conduct of regional anesthesia cannot be overemphasized. Experience from this case suggests that local anesthesia toxicity can happen within safe dose limits and without intravascular placement despite careful attention to needle and catheter placement, fractionated dosing and frequent aspirations.

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“…Two patients suffered cardiac arrest and one patient developed ventricular fibrillation following excessive doses of ropivacaine. [4][5][6] In this issue of the Canadian Journal of Anesthesia there is an additional report of ventricular fibrillation following an accidental intravascular injection of ropivacaine. 7 There were some interesting aspects about this case that are worthy of comment.…”

mentioning

confidence: 99%

“…Deux patients ont subi un arrêt cardiaque et un patient a été victime de fibrillation ventriculaire après avoir reçu des doses excessives de ropivacaïne. [4][5][6] Dans le présent numéro du Journal, un nouvel article rapporte de la fibrillation ventriculaire suivant l'injection intravasculaire accidentelle de ropivacaïne. 7 Certains aspects intéressants de ce cas méritent d'être commentés.…”

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Ropivacaine cardiac toxicity — not as troublesome as bupivacaine

Finucane

2005

Can J Anesth/J Can Anesth

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Ropivacaine-induced Cardiac Arrest after Peripheral Nerve Block: Successful Resuscitation

Cited by 68 publications

References 16 publications

Successful defibrillation immediately after the intravascular injection of ropivacaine

Successful defibrillation immediately after the intravascular injection of ropivacaine

Case report: Ropivacaine neurotoxicity at clinical doses in interscalene brachial plexus block

Ropivacaine cardiac toxicity — not as troublesome as bupivacaine

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