MALIGNANT VENTRICULAR DYSRHYTHMIAS IN A PATIENT WITH ISOVALERIC ACIDEMIA RECEIVING GENERAL AND LOCAL-ANESTHESIA FOR SUCTION LIPECTOMY

We report the occurrence of severe ventricular arrhythmias in a patien t with isovaleric acidemia during general anesthesia for suction lipec tomy. The timing of events and character of the ECG changes are most c onsistent with bupivacaine toxicity after subcutaneous injection of lu mescence solution containing this local anesthetic. The patient had pr eviously documented carnitine deficiency, a condition which, we specul ate, may lower the threshold for bupivacaine induced cardiotoxicity. W e review clinical considerations in isovaleric acidemia and conclude t hat the use of bupivacaine in these patients probably should be avoide d. (C) 1997 by Elsevier Science Inc.