Lipid rescue for bupivacaine toxicity during cardiovascular procedures

Bupivacaine toxicity is a recognized complication of procedures done under local anesthetic infiltration. While local anesthetic toxicity is rare, it is potentially catastrophic and life-threatening. A 20% lipid emulsion has been used to resuscitate patients after bupivacaine overdose or inadvertent intravascular injection. While the use of lipid emulsion for local anesthetic toxicity has been reported extensively in the anesthesia literature, it has not yet been reported in the cardiology literature. We report a case of local anesthetic toxicity resulting in pulseless electrical activity during an electrophysiology procedure that was successfully treated by infusion of 20% lipid emulsion.