Korean J Anesthesiol.  2008 Dec;55(6):756-760. 10.4097/kjae.2008.55.6.756.

Hyperkalemic cardiac arrest triggered by intravenous lidocaine following axillary brachial plexus block for the creation of an arteriovenous fistula: A case report

• Song SY
• Shin HD
• Seo KC
• Chung JY
• Roh WS
• Kim BI

• KMID: 1782556
• DOI: http://doi.org/10.4097/kjae.2008.55.6.756

Abstract

Axillary brachial plexus blockade (BPB) is commonly used as an anesthetic method for patients undergoing the creation of an arteriovenous fistula (AVF) during end-stage renal disease (ESRD). Several studies have shown that the combination of intravenous lidocaine and hyperkalemia in ESRD can produce severe conduction disturbance and asystole. Here, we report a case of cardiac arrest in a 41 year old male patient who manifested severe cardiac conduction disturbance during creation of an AVF. Sixty-five minutes after BPB, the intravenous therapeutic doses of lidocaine administered to treat frequent premature ventricular contractions aggravated his heart rhythm and produced a sine wave and ventricular fibrillation. It was assumed that ventricular fibrillation was induced by a combination of local anesthetics administered during BPB and systemic hyperkalemia as a result of the ESRD [ED highlight-please ensure my changes do not alter your intended meaning]. The patient was completely resuscitated 45 minutes after the cardiopulmonary resuscitation and correction of the hyperkalemia.

Keyword

arteriovenous fistula; brachial plexus block; end-stage renal disease; hyperkalemia; lidocaine

MeSH Terms

Anesthetics, Local
Arteriovenous Fistula
Brachial Plexus
Cardiopulmonary Resuscitation
Dietary Sucrose
Heart
Heart Arrest
Humans
Hyperkalemia
Kidney Failure, Chronic
Lidocaine
Male
Ventricular Fibrillation
Ventricular Premature Complexes
Anesthetics, Local
Dietary Sucrose
Lidocaine