Treatment with lipid therapy to resuscitate a patient suffering from toxicity due to local anesthetics

Recently, although without a universal recognition, the use of lipid emulsions as a rescue therapy for the bupivacaine cardiac toxicity has been proposed. In this article we report a successful resuscitation of a patient after the injection of bupivacaine in emergency room and a commented review of the related literature. The patient is a 73 years old man that, after a subcutaneous injection of bupivacaine (0.5%, i.e. 0.5 mL/h), developed circulatory arrest. After the failure of the initial treatment based on the advanced life support protocol, we have successfully performed a therapy with lipid emulsion. The bupivacaine intravascular injection, together with its interaction with amitriptyline and carbamazepine, could lead to cardiac depression, severe arrhythmias, hypotension, and/or cardiac arrest. In the case of failure of traditional life support treatment, intravenous lipid emulsion proves to be the best therapy to treat bupivacaine systemic toxicity.