Cardiac arrest after epidural anesthesia for a esthetic plastic surgery: a case report

Cardiopulmonary resuscitation in prone position: A scoping review

“…We found no RCT comparing prone to standard supine CPR. Three of the included studies [ [9] , [10] , [11] ] had a nonrandomized design and 31 were case reports [ [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] ]. In this section, the included nonrandomized studies are described; a complete description of all the studies, including case reports, is provided with details in Table 1 .…”

“…Survived without sequelae at 24 months Burki et al (2017) [ 15 ] Case report Operating room (Fourth ventricle tumour excision); Pakistan 6 years old female patient Intraoperative cardiac arrest, due to massive bleeding (estimated blood loss 2 l) CPR in prone position ROSC and ICU admission. Death at day 5 after surgery Kaloria et al (2017) [ 16 ] Case report Operating room (Tethered cord release and removal of bony spur); India 1 year old girl Electromechanical dissociation, possibly due to venous air embolism CPR in prone position ROSC, surgery completion, discharge at day 6 Lee-Archer and Chaseling (2017) [ 17 ] Case report Operating room (Posterior spinal fusion C5 to L4, for severe kyphoscoliosis); Australia 10 years old girl Cardiac arrest during attempts to locate the epidural space with a loss of resistance air technique, possibly due to air embolism Supination and standard CPR ROSC, completion of surgery at day 4, right-sided brain infarction and left upper limb weakness, recovered after two weeks Pinheiro et al (2017) [ 18 ] Case report Operating room (Esthetic lipoplasty) 25 years old female patient Asystole Supination and standard CPR ROSC, surgery cancelled, ICU admission, discharge Taylor et al (2013) [ 19 ] Case report Operating room (Craniotomy for metastatic melanoma); New Zeland 69 years old male patient with hypertrophic cardiomyopathy and impaired (34%) ejection fraction Pulseless VT, then VF. CPR in prone position ROSC.…”

Local Anesthetic Systemic Toxicity

“…5,7,12,[15][16][17]23,24,29 Seven patients needed advanced cardiac life support, which was either explicitly named by the authors or described as chest compressions with administration of inotropes/vasopressors. One patient needed basic life support.…”

“…5,9,11,17,23,[32][33][34] The remaining cases resulted from neuraxial (13%: 4 of the 6 were epidural, 2 were described specifically as caudal injections), 16,20,26,29,30,38 paravertebral blocks (8.5%), 15,21,22,30 lower (8.5%) 6,7,13 and upper (8.5%) 6,31,36,39 extremity blocks, head and neck blocks (8.5%) (maxillary nerve, peribulbar), 14,19 topical, 28,35,37 transabdominis plane blocks, 8 and intravenous administration. 18 Seven cases (15%) involved continuous infusions of local anesthetic.…”

“…9,11,13,15,16,19,29,33,34,38 In 2 cases, the presence or absence of an intravascular marker was irrelevant. In 1 case, the local anesthetic was purposefully injected intravenously to blunt the clinical response to tracheal extubation, 18 and in another, the patient self-administered a topical preparation.…”