Lipid resuscitation in a carnitine deficient child following intravascular migration of an epidural catheter

Summary A child with cerebral palsy and carnitine deficiency developed ventricular arrhythmias with loss of cardiac output during elective surgery under general anaesthesia with concomitant epidural analgesia. Sinus rhythm was restored on administration of adrenaline, but hypotension persisted despi...

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Bibliographic Details
Published in:Anaesthesia 2010-02, Vol.65 (2), p.192-195
Main Authors: Wong, G. K., Joo, D. T., McDonnell, C.
Format: Article
Language:English
Subjects:
Analgesia, Epidural - adverse effects
Analgesia, Epidural - instrumentation
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthetics, Local - adverse effects
Biological and medical sciences
Blood pressure
Bupivacaine - adverse effects
Carnitine - deficiency
Cerebral palsy
Cerebral Palsy - complications
Child
Fat Emulsions, Intravenous - therapeutic use
Foreign-Body Migration - complications
Heart Arrest - chemically induced
Heart Arrest - therapy
Humans
Intraoperative Complications - chemically induced
Intraoperative Complications - therapy
Lipids
Male
Medical sciences
Medication Errors - adverse effects
Surgery
Toxicity
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Summary:Summary A child with cerebral palsy and carnitine deficiency developed ventricular arrhythmias with loss of cardiac output during elective surgery under general anaesthesia with concomitant epidural analgesia. Sinus rhythm was restored on administration of adrenaline, but hypotension persisted despite resuscitation. Bolus administration of 0.8 ml.kg−1 (20 ml) lipid emulsion resulted in rapid improvement in cardiac output. Blood samples taken before and after the lipid bolus did not demonstrate toxic concentrations of bupivacaine. This case suggests that carnitine deficiency may increase susceptibility to bupivacaine cardiotoxicity.
ISSN:0003-2409
1365-2044
DOI:10.1111/j.1365-2044.2009.06131.x