Sudden cardiac arrest during cesarean section due to epidural anaesthesia using ropivacaine: a case report

Abstract

Sudden cardiac arrest occurred subsequent to epidural anaesthesia in the patient of elective cesarean section. During cardio-pulmonary resuscitation, immediate section saved the infant and the mother recovered completely. Serial ropivacaine concentrations in maternal serum evaluated potential risk of epidural anaesthesia with ropivacaine. A 39-year-old primirapa woman with an 11-year aortitis syndrome (Takayasu disease) was presented. Low dose aspirin of 81 mg per every 3 day and prednisolone of 12 mg per every 2 day maintained her aortitis in good control through pregnancy. An elective cesarean section was planned preventively because of aortitis at 38 weeks of gestation. As an epidural anaesthesia, 20 ml of 1% ropivacaine was injected by one shot from 3/4 lumbar supine through median approach with an appropriate tube testing method in the operation room. At 22 min after injection, a sudden cardiac arrest following to two times of pulse-less VT (Ventricular tachycardia) and systemic convulsion occurred. Immediate defibrillation of 200 J was performed promptly, and cesarean section delivered a healthy boy of 2,655 g with APGAR scores of 10 points at 1 and 5 min, respectively. Both mother and neonate were discharged from hospital at 11th day without sequare. Ropivacaine was proved to be a cardio-toxic agent in the case. However, immediate resuscitation and operative delivery served good prognosis for mother and neonate.