Question

A young male was given regional anaesthesia with 0.25% bupivacaine. The pt. Become unresponsive & pulse become unrecordable. Best Management would be

• A. CPCR with 20% Intralipid
• B. CPCR with sod. Bicarbonate
• C. CPCR with dobutamine
• D. CPCR with calcium

Answer 1

The Correct Option is A

In this scenario, the patient has likely experienced a bupivacaine-induced cardiotoxicity, which is a rare but serious complication of regional anesthesia. Bupivacaine can cause cardiovascular collapse by disrupting normal cardiac electrical activity and myocyte function.

To manage this situation effectively, Cardiopulmonary Cerebral Resuscitation (CPCR) is required combined with administration of 20% Intralipid. This combination is recommended because:

• Lipid emulsion therapy (Intralipid) acts as a 'lipid sink' to bind the lipophilic bupivacaine, reducing its free plasma concentration and toxicity.
• This treatment helps in reversing cardiac and neurological symptoms by restoring normal cardiac function.

Hence, the best management for this case is: CPCR with 20% Intralipid.