Malignant ventricular dysrhythmias in a patient with isovaleric acidemia receiving general and local anesthesia for suction lipectomy

We report the occurrence of severe ventricular arrhythmias in a patient with isovaleric acidemia during general anesthesia for suction lipectomy. The timing of events and character of the ECG changes are most consistent with bupivacaine toxicity after subcutaneous injection of tumescence solution co...

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Bibliographic Details
Published in:Journal of clinical anesthesia 1997-12, Vol.9 (8), p.668-670
Main Authors: Weinberg, Guy L., Laurito, Charles E., Geldner, Peter, Pygon, Bernard H., Burton, Barbara K.
Format: Article
Language:English
Subjects:
Acidemia, isovaleric
Acidosis - complications
Acidosis - metabolism
Adolescent
Anesthesia, General
Anesthesia, Local
Anesthetics, Local - adverse effects
arrhythmias
bupivacaine
Bupivacaine - adverse effects
carnitine
Carnitine - metabolism
Electrocardiography
Female
Humans
Intraoperative Complications - physiopathology
Lipectomy
Pentanoic Acids - metabolism
Ventricular Dysfunction - etiology
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Summary:We report the occurrence of severe ventricular arrhythmias in a patient with isovaleric acidemia during general anesthesia for suction lipectomy. The timing of events and character of the ECG changes are most consistent with bupivacaine toxicity after subcutaneous injection of tumescence solution containing this local anesthetic. The patient had previously documented carnitine deficiency, a condition which, we speculate, may lower the threshold for bupivacaine induced cardiotoxicity. We review clinical considerations in isovaleric acidemia and conclude that the use of bupivacaine in these patients probably should be avoided.
ISSN:0952-8180
1873-4529
DOI:10.1016/S0952-8180(97)00187-6