Citation

Dudley MH, Fleming SW, Garg U, Edwards JM. J. Forensic Sci. 2011; 56(5): 1376-1379.

Affiliation

Office of the Jackson County Medical Examiner, 660 East 24th Street, Kansas City, MO. University of Missouri Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO. Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO. PremierTox Laboratory, 2431 Lakeway Drive, Suite 17A1, Russell Springs, KY.

Copyright

(Copyright © 2011, American Society for Testing and Materials, Publisher John Wiley and Sons)

DOI

10.1111/j.1556-4029.2011.01829.x

PMID

21790593

Abstract

This case represents unusual findings of elevated bupivacaine and tryptase concentrations following local anesthetic, bupivacaine, administered as a scalene nerve block for elective rotator cuff repair surgery. Following bupivacaine injection, the patient exhibited almost immediate seizure activity, bradycardia, and cardiac arrest. Resuscitative efforts including cardiopulmonary bypass restored a cardiac rhythm. However, the clinical medical status of the patient progressively declined and he died 7 h following administration of the local anesthetic. Autopsy revealed several abnormalities of the heart including cardiomegaly, myocardial bridging, and lipomatous hypertrophy of the intraatrial septum, which may have contributed to bradycardia and arrhythmia. Postmortem toxicology results revealed elevated bupivacaine and tryptase concentrations. Elevated postmortem bupivacaine concentrations 7 h following administration and abrupt onset of seizures indicate unintentional intravascular injection instead of nerve and tissue infiltration. An elevated postmortem tryptase concentration points to the possibility of a hypersensitivity reaction to bupivacaine.

Language: en