Lipid resuscitation in a carnitine deficient child following intravascular migration of an epidural catheter*

Authors

  • G. K. Wong,

    1. Assistant Professors and Staff Anesthesiologists, Department of Anesthaesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Ontario, Canada
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  • D. T. Joo,

    1. Assistant Professors and Staff Anesthesiologists, Department of Anesthaesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Ontario, Canada
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  • C. McDonnell

    1. Assistant Professors and Staff Anesthesiologists, Department of Anesthaesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Ontario, Canada
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  • *

    Presented in part at the Canadian Anesthesiologists’ Society Annual Meeting, Vancouver; June 2009.

Correspondence to: Dr Gail K. Wong
E-mail: gail.wong@sickkids.ca

Summary

A child with cerebral palsy and carnitine deficiency developed ventricular arrhythmias with loss of cardiac output during elective surgery under general anaesthesia with concomitant epidural analgesia. Sinus rhythm was restored on administration of adrenaline, but hypotension persisted despite resuscitation. Bolus administration of 0.8 ml.kg−1 (20 ml) lipid emulsion resulted in rapid improvement in cardiac output. Blood samples taken before and after the lipid bolus did not demonstrate toxic concentrations of bupivacaine. This case suggests that carnitine deficiency may increase susceptibility to bupivacaine cardiotoxicity.

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