Severe bradycardia and bradypnea following vaginal oocyte retrieval: a possible toxic effect of paracervical mepivacaine

We report a case of a patient with a history of heart conduction disease, s ymptom-free and without treatment in the last years, who experienced a seve re cardiac complication associated with in vitro fertilization (IVF) with v aginal oocyte retrieval (VOR). Eighty-five minutes after the VOR a severe b radycardia and bradypnea occurred, requiring an emergency application of a pacemaker. Presumably the condition occurred because of a toxic effect of t he 400 mg of mepivacaine administered paracervically. It is concluded that in the paracervical anesthesia in the IVF cycles the therapeutic range shou ld be scrupulously followed in patients with heart condition. (C) 2000 Else vier Science Ireland Ltd. All rights reserved.