(Sep-2003 Q7) At the end of an open cholecystectomy, intercostal nerve blocks with a total of 20ml bupivacaine 0.5% are placed at two levels while the patient is still under general endotracheal anaesthesia. The patient develops ventricular fibrillation within 3 minutes. Describe your management of this situation.
The patient has received 20x5mg =100mg of bupivacaine and the weight of the patient is not known here but given the short duration prior to cardiac arrest, the most likely differential in this situation is cardiovascular collapse from LA toxicity. Other less likely differentials would be a acute coronary event due to underlying ischaemic heart disease or arrhythmias.
The immediate management of this patient will include resuscitation according to BCLS protocols while maintaining the airway and breathing by leaving the patient intubated, 100% O2 and commencing CPR and defibrillation. IV adrenaline boluses 1mg of 100mcg/ml dilution and magnesium may be given. ?phenytoin.
Lipofundin as been shown to be effective in ???? it is available as given via a large bore IV line as a rapid bolus of 100ml followed by 400ml
The surgical team and family has to be informed and the patient admitted to SICU after successful resuscitatoin. ? maintainence lipofundin?Incident reporting and post event counselling.
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