Foal's heart stopped after lidocaine - how lipid helped

Abstract

BACKGROUND: Lipid emulsion has been reported to be effective for the treatment of local anaesthetic overdoses in rats, dogs and man. OBJECTIVES: To describe the successful treatment of cardiovascular lidocaine toxicity in a foal with intravenous lipid administration. STUDY DESIGN: Observational study: case report. METHODS: An 8-month-old Arabian cross foal was anaesthetised for removal of the right alar fold and nasal plate. Anaesthesia was maintained with isoflurane in oxygen and lidocaine administered with a loading dose followed by a continuous rate infusion (CRI). The anaesthetic period was uneventful and 30 min before expected termination of the procedure lidocaine infusion was stopped. A sudden drop in mean arterial blood pressure was then observed. The ECG signal was lost, the end tidal COtension dropped from 40 to 10 mmHg, corneal reflex was absent and asystole diagnosed. Cardiopulmonary resuscitation manoeuvres were immediately initiated, but epinephrine and atropine were unsuccessfully administered. Lipid emulsion was administered and the heart rate and arterial blood pressure gradually returned to normal. RESULTS: The foal recovered consciousness 3 h later, regained its sternal position, was responsive and 20 h later was able to stand up alone. MAIN LIMITATIONS: It will be necessary to evaluate a greater number of cases to determine the effectiveness of lipids in foals intoxicated with lidocaine. CONCLUSION: Intravenous lipid emulsion may be helpful in the treatment of potentially lethal cardiotoxicity attributable to lidocaine overdose in the foal.