Deaths of patients during elective surgery have drawn attention to the danger of
anesthesia. Tumescent
local anesthesia is subcutaneous infiltration of large volumes of dilute
lidocaine with
epinephrine to produce vasoconstriction while delivering
anesthesia over large areas without
lidocaine toxicity. This report documents the case of a 38-year-old woman who attended an outpatient clinic to undergo
liposuction of the abdomen and bilateral hips and thighs. According to one witness, around 30 min after
anesthesia administration, the victim suffered an episode of
tonic-clonic convulsion. When the emergency medical services arrived the patient was in
asystole. She died in spite of attempted
cardiopulmonary resuscitation. The patient had no significant past medical history including no history of
allergies or any known complications with
anesthesia. A complete autopsy was performed and possible causes of death such as
myocardial infarction, aspiration of food or
foreign body, and
pulmonary embolism were discarded.
Anaphylactic shock was considered a possible but unlikely explanation for the fatality. Toxicological analyses revealed the presence of
lidocaine and
mepivacaine in heart blood, at concentrations of 4.9 and 16.2mg/L, respectively. All drugs involved in the case were detected using gas chromatography with
nitrogen-
phosphorus detector and confirmed using gas chromatography-mass spectrometry full scan mode after solid-phase extraction using Chem-Elut columns. An additional high-performance liquid chromatography coupled to diode-array detection screening also obtained the same results. Based on the autopsy findings, case history, and toxicology results, the forensic pathologists ruled that the cause of death was an overdose of
local anesthetic agents. The Court of Law ruled the death as an involuntary homicide due to gross negligence.