[A Case of Cardiac Arrest following Intra-articular Administration of Levobupivacaine during Total Knee Arthroplasty].

A 73-year-old woman with normal cardiac function underwent an elective total knee arthroplasty. After skin closure, levobupivacaine 225 mg was injected into the knee and 25 mg was injected subcutaneously. The patient recovered from general anesthesia 5 min after the surgery. Thirty five min after surgery, while in general radiology department her carotid arterial pulses were not palpable. Cardiopulmonary resuscitation (CPR) was initiated with intravenous (i.v.) administration of adrenaline 1 mg. Circulation was rapidly restored. Coronary angiography demonstrated no coronary stenosis; however, left ventriculography demonstrated takotsubo cardiomyopathy. The patient regained consciousness, but pulmonary edema and renal failure became worse. On postoperative day 2, continuous hemodialysis was instituted. Weaning from ventilatory support was completed on postoperative day 3; hemodialysis was stopped on day 14; and the patient left the intensive care unit on day 15. We believe cardiac arrest may have been precipitated by local anesthetic systemic toxicity (LAST), and administration of i. v. adrenaline 1 mg may have resulted in pulmonary edema. Patients should be carefully observed following local anesthetic with attention given to the side-effects of i. v. adrenaline.