Key result
An 11-month-old infant developed ventricular tachycardia following an excessive dose of 0.5% bupivacaine for a penile block, and was successfully resuscitated with intralipid.
Case Report (n=1)
This case highlights the successful use of intralipid for bupivacaine-induced ventricular tachycardia in an infant and emphasizes the need for strict communication protocols for local anesthetic dosing.
Supports intralipid rescue in infant LAST; leaves open need for stricter pediatric dosing guidelines.
An otherwise healthy 11-month-old, 8-kg infant presented for an elective circumcision. After a penile block with an excessive dose of 0.5% bupivacaine, the patient progressed to ventricular tachycardia. He was resuscitated with intralipid and had an uneventful recovery. The case was classified as a serious safety event, and a team was created to perform a root cause analysis. A sequence of events was constructed from gathered data, and policies and procedures were reviewed. Proximate cause was determined to be the failure of the surgeon, anesthesiologist, nurse, and scrub technician to communicate about the maximum dose of local anesthetic allowed before the medication being drawn up. Interventions were developed to target the proximate and contributing causes.
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Buck et al. (2014) conducted a case report in Ventricular tachycardia secondary to local anesthetic toxicity (n=1). 0.5% bupivacaine was evaluated on Ventricular tachycardia and recovery. An 11-month-old infant developed ventricular tachycardia following an excessive dose of 0.5% bupivacaine for a penile block, and was successfully resuscitated with intralipid.
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