Bupivicaine induced dysrythmias

[MAC10]

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God forbid I ever see it, but what is the current thought on treating this? DO you guys reach for the Lidocaine or another antiaryth?

 

[zippy2u]

Put a bottle of bretylium in your back pocket to ward off those CV toxicity heebie jeebies ----Regards ---Zippy

 

[militarymd]

CPR and go on bypass

 

[UTSouthwestern]

Do NOT give lidocaine. Airway management, fluids, hefty doses of epi, hyperventilation/bicarb to correct acidosis, and CPB if available are necessary if the patient experiences CV collapse. Bretylium is the DOC for arrythmias caused by bupivicaine.

 

[proman]

Isn't bretylium no longer made? Scarcity of raw material I think was the reason all manufacturers stopped production.

 

[thegasman]

we don't have bretylium and our staff says amio is rx for bupiv induced arrhythmia.

 

[UTSouthwestern]

Isn't bretylium no longer made? Scarcity of raw material I think was the reason all manufacturers stopped production.

No longer made, but still available in many hospitals, including the ones I currently work in. It is actually held in reserve for just such an emergency.

Amio is OK as long as the arrythmia is not an AV block or nodal bradycardia.

 

[hokie]

You should also consider intravenous lipid emulsion for refractory cases... granted ABC's / ACLS of course should come first (and it will probably take time to get intralipid from the pharmacy). Some have advocated propofol (as it is formulated with lipid). It is thought that the lipid removes the local anesthestic molecules from whatever binding site causes the cardiovascular depression. I'll try to post citations if anyone is interested...

 

[DrDre']

Hokie, I would be interested. 🙂

 

[Noyac]

Do NOT give lidocaine. Airway management, fluids, hefty doses of epi, hyperventilation/bicarb to correct acidosis, and CPB if available are necessary if the patient experiences CV collapse. Bretylium is the DOC for arrythmias caused by bupivicaine.

This just brings something to mind. In the event of a cocaine overdose you would not want to give lidocaine for arrythmias if I remember right. I do remember the treatment also.
















VALIUM!

 

[beezar]

Not giving lidocaine for a local anesthetic toxicity reaction (from bupivacaine, cocaine, etc) just seems logical to me, being that lidocaine itself is a local anesthetic.

But does amio really work for cardiac arrhythmias from bupivacaine? or is it just speculation?