A Neonate with Long QT Syndrome, Refractory Ventricular Arrhythmias, and Lidocaine Toxicity

• Published in: Anesthesia and analgesia Vol. 114; no. 2; pp. 407 - 409
• Main Authors: Nathan, Aruna T., Naim, Maryam, Montenegro, Lisa M., Vetter, Victoria L.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01-02-2012; Lippincott Williams & Wilkins
• Subjects: Amiodarone - administration & dosage; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Anesthetics, Local - pharmacokinetics; Anti-Arrhythmia Agents - administration & dosage; Anti-Arrhythmia Agents - adverse effects; Anti-Arrhythmia Agents - pharmacokinetics; Biological and medical sciences; Cardiac Pacing, Artificial; DNA Mutational Analysis; Drug Interactions; Drug Substitution; Drug Therapy, Combination; Humans; Infant, Newborn; Lidocaine - administration & dosage; Lidocaine - adverse effects; Lidocaine - pharmacokinetics; Long QT Syndrome - diagnosis; Long QT Syndrome - drug therapy; Long QT Syndrome - genetics; Male; Medical sciences; Propanolamines - administration & dosage; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - drug therapy; Tachycardia, Ventricular - genetics; Human; Arrhythmia; Toxicity; Prolonged QT interval; Cardiovascular disease; Anticonvulsant; Antiarrhythmic agent; Conduction disorder; Local anesthetic; Newborn; Heart block; Heart disease; Anesthesia; Organic amide; Lidocaine
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ANE.0b013e31823ed423

Long QT syndrome is characterized by electrocardiographic appearance of long QT intervals and propensity to polymorphic ventricular tachycardia. Aggressive anticipatory clinical management is required for a good outcome, especially in the symptomatic neonate. We present a neonate with a compound mutation with refractory ventricular tachycardia that necessitated multimodal pharmacotherapy with lidocaine, esmolol, and amiodarone along with ventricular pacing. Despite normal serum lidocaine levels, complex pharmacokinetic interactions resulted in presumed neurotoxicity due to lidocaine. This report discusses the implications and challenges of management of a neonate with compound long mutations.