Cardiac Arrest in A Young Boy: A Case of Local Anesthetic Toxicity

A 6-year-old boy with congenital glaucoma was to undergo hypospadias repair. General anesthesia was inducted with fentanyl 100mcg, Propofol 60mg, and Rocuronium 15mg. Volume controlled mechanical ventilation was started and a caudal block in lateral position was performed without difficulty with 2mL of 0.5% bupivacaine with epinephrine. However in some time, patient when in supine position presented hypotension (BP 60/32 mmHg) and HR = 176 bpm. Amiodarone hydrochloride 50mg and epinephrine 20mcg reverted the rhythm to sinus (HR = 148 bpm, BP = 80 × 45mmHg).

FiO2 was raised to 100%. In a couple of minutes, the patient had cardiac arrest (pulseless ventricular tachycardia interspersed with ventricular fibrillation). Again Amiodarone (50mg) and epinephrine (40 mcg) were given and a three-time one-minute intravenous bolus injection of 20% lipid emulsion was prompted for 30 minutes. Later…