LipidRescue™ Resuscitation

Mid-60’s female for total shoulder arthroplasty. Placed interscalene catheter, running ropivacaine 0.2% at 8ml/hr. Surgery uncomplicated. Rounded on her the next day. Shoulder comfortable. A bit groggy. Overnight had been hypertensive, IM had restarted her antihypertensives and given a few prn doses to “catch her up”. By noon she was profoundly hypotensive (60’s/30’s) and bradycardic in mid 40’s, brought to ICU for initiation of dopamine for presumed cardiogenic shock while undergoing EKG and drawing troponins. She had made no urine for several hours. ICU called anesthesia “to see if I thought she had a sympathectomy “ from the nerve block. I came to bedside, bolused interlipid and ran infusion, removed nerve catheter, turned off dopamine. Immediate BP improved to 120’s/50’s, she started making urine after 10 min, and her mental fog cleared dramatically. The improvement was remarkable even during the bolus of interlipid. Her troponins were 0.0, EKG was Brady sinus. She was very stable overnight and went home next morning.