Massive Lignocaine Overdose During Cardiopulmonary Bypass

Abstract

A case of accidental massive overdose of lignocaine while a patient was on cardiopulmonary bypass is described. The benefits of cardiopulmonary bypass and cardiac pacing in the management of the patient are discussed.

Extracorporeal cardio-pulmonary resuscitation in poisoning: A scoping review article

“…Of the 85 studies eventually included in the qualitative synthesis, 15 articles were case series [ Table 1 ] [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] while 58 were individual cases [ Table 2 , Supplement 1] [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , …”

Massive lignocaine overdose while on veno-arterial extracorporeal membrane oxygenation (VA ECMO)

“…Toxicity, when it occurs, manifests primarily with peripheral and central nervous system effects ranging from sensory disturbances and fasciculations to seizures [10] , and cardiac ones including bradycardia and other arrythmias [7] . Management of lignocaine toxicity is largely supportive, involving airway and haemodynamic support, including extracorporeal cardiorespiratory suport if necessary [11] , and control of seizures with benzodiazepines [7] , [12] . Infusion of a 20 % lipid emulsion is a therapy the use of which is supported largely by case reports; it is hypothesised to reduce toxicity primarily by acting as a sink for the drug (due to its high lipid solubility), with other possible effects on its distribution or metabolism [13] .…”

Treatment of local anaesthetic induced cardiotoxicity with lipid infusion

“…Two cases of successful resuscitation of LA overdose with cardiopulmonary bypass exist in the literature (Long et al 1989;Noble et al 1984). Nevertheless, its use will be limited due to its practicability and unavailability in most settings (Noble et al 1984).…”

“…Two cases of successful resuscitation of LA overdose with cardiopulmonary bypass exist in the literature (Long et al 1989;Noble et al 1984). Nevertheless, its use will be limited due to its practicability and unavailability in most settings (Noble et al 1984). More recently, first case studies using lipid infusions in patients after accidental local anaesthetic overdose have been described (Foxall et al 2007;Litz et al 2006;Rosenblatt et al 2006;Salomaki et al 2005;Zimmer et al 2007).…”