This is the first reported case of death in which the mepivacaine concentration in cerebrospinal fluid has been determined following epidural anesthesia.
May signal epidural mepivacaine toxicity risk; extends sparse postmortem data but leaves toxic thresholds undetermined.
A fatal case involving mepivacaine-induced epidural anesthesia is described. The pathological findings were typical of cardiac shock from ischemic origin. Cerebrospinal fluid (CSF) was obtained several hours after death and mepivacaine was identified by gas chromatography-mass spectrometry (GC-MS). Its concentration was determined by high performance liquid chromatography with diode array detection (HPLC-DAD). Extraction from CSF was performed by deproteinization with acetonitrile. The mepivacaine concentration in the sample was 264 microg/mL. Concentrations of mepivacaine in CSF following epidural anesthesia are not reported in literature to our knowledge. This is the first reported case of death in which the mepivacaine concentration in CSF has been determined.
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Nieddu et al. (2007) studied this question.
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