Post Your Cases > LAST event after infiltrative anesthesia with cardiac arrest
We report the case of the LAST event after infiltrative anesthesia to perform liver fine-needle aspiration biopsy under US guidance. 63 year old male with cancer presented for liver fine-needle aspiration biopsy with US guidance. Weight 65 kg. Height 174 cm. Patient had a history with local lidocaine anesthesia without any complications. After infiltrative anesthesia lidocaine 1% - 20 ml , performed by a surgeon , the patient showed the anxiety, muscle twitching, agitation, and ultimately, seizures. The resuscitation team was called. When the resuscitation team arrived , the patient was unresponsive and had seizure activity. Intravenous access was provided ( the patient had a subcutaneous port into which the huber's needle was inserted). Oxygen was administered by face mask. During the intravenous administration of diazepam, the patient had respiratory and cardiac arrest. Considered local anesthetic systemic toxicity (LAST). Started: CPR, orotracheal intubation. Two boluses of 50 ml of 20% intravenous lipid emulsion were given followed by an infusion of just under 0.25ml/kg/min. During CPR epinephrine - 3 mg were given totally. After lipid infusion ( 200 ml totally, 3 ml/kg) the patient was in sinus rhythm and had a pulse: HR 110-120 per minute, BP = 146/95, SpO2 =100%, but he was unconscious. Intubated patient was transferred to the ICU. After 4 hours he was extubated without neurological deficit. LAB: First hour: Troponin I = 15 ( 0 -29 ng/l) + ECG normal + echocardiography: VE = 46-48% (Simpson biplane), hypokinesis of LV's apical part After 6 hours: Troponin I = 73,9 ( 0 -29 ng/l) + ECG normal+ without cardial complaints After 12 hours: Troponin I = 85 ( 0 -29 ng/l) + ECG normal + without cardial complaints After 16 hours: depression ST < 2 mm V5,V6, without cardial complaints Сoronary angiography: without critical stenosis.
63 year old male with cancer presented for liver fine-needle aspiration biopsy with US guidance. Weight 65 kg. Height 174 cm.
Patient had a history with local lidocaine anesthesia without any complications.
After infiltrative anesthesia lidocaine 1% - 20 ml , performed by a surgeon , the patient showed the anxiety, muscle twitching, agitation, and ultimately, seizures.
The resuscitation team was called.
When the resuscitation team arrived , the patient was unresponsive and had seizure activity.
Intravenous access was provided ( the patient had a subcutaneous port into which the huber's needle was inserted).
Oxygen was administered by face mask.
During the intravenous administration of diazepam, the patient had respiratory and cardiac arrest.
Considered local anesthetic systemic toxicity (LAST).
Started: CPR, orotracheal intubation. Two boluses of 50 ml of 20% intravenous lipid emulsion were given followed by an infusion of just under 0.25ml/kg/min.
During CPR epinephrine - 3 mg were given totally.
After lipid infusion ( 200 ml totally, 3 ml/kg) the patient was in sinus rhythm and had a pulse: HR 110-120 per minute, BP = 146/95, SpO2 =100%, but he was unconscious.
Intubated patient was transferred to the ICU. After 4 hours he was extubated without neurological deficit.
LAB:
First hour: Troponin I = 15 ( 0 -29 ng/l) + ECG normal + echocardiography: VE = 46-48% (Simpson biplane), hypokinesis of LV's apical part
After 6 hours: Troponin I = 73,9 ( 0 -29 ng/l) + ECG normal+ without cardial complaints
After 12 hours: Troponin I = 85 ( 0 -29 ng/l) + ECG normal + without cardial complaints
After 16 hours: depression ST < 2 mm V5,V6, without cardial complaints
Сoronary angiography: without critical stenosis.