During axillary brachial plexus block, a patient receives bupivacaine and within two minutes develops seizures followed by refractory ventricular fibrillation unresponsive to standard defibrillation. Alongside ACLS protocols, the specific antidotal therapy indicated is:

• A Intralipid 20% bolus of 1.5 mL/kg ✓
• B Magnesium sulphate 2 g intravenously
• C Amiodarone 300 mg intravenously
• D Naloxone 0.4 mg intravenously

Explanation

Bupivacaine binds cardiac sodium channels avidly and dissociates slowly, producing cardiotoxicity that resists conventional resuscitation. Lipid emulsion therapy (Intralipid 20%, 1.5 mL/kg bolus followed by infusion 15 mL/kg/hour) creates a lipid sink that extracts lipophilic drug from cardiac tissue and supplies substrate for myocardial metabolism. Amiodarone may be used per ACLS but does not reverse local anaesthetic toxicity specifically. Magnesium and naloxone have no role in this setting.

Reference: Miller's Anesthesia, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.