Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity

• Published in: Regional anesthesia and pain medicine Vol. 28; no. 3; pp. 198 - 202
• Main Authors: Weinberg, Guy, Ripper, Richard, Feinstein, Douglas L., Hoffman, William
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.05.2003; BMJ Publishing Group LTD
• Subjects: Anesthetics, Local - adverse effects; Anesthetics, Local - toxicity; Animals; Blood Pressure - drug effects; Bupivacaine - antagonists & inhibitors; Bupivacaine - toxicity; Carbon Dioxide - blood; Dogs; Fat Emulsions, Intravenous - therapeutic use; Heart Arrest - chemically induced; Heart Arrest - prevention & control; Heart Rate - drug effects; Hemodynamics - drug effects; Hydrogen-Ion Concentration; Myocardial Contraction - drug effects; Myocardium - metabolism; Oxygen - blood; Oxygen Consumption - drug effects; Regional anesthesia
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1053/rapm.2003.50041

Background and Objectives: We previously demonstrated in rats that intravenous infusion of a lipid emulsion increases survival in resuscitation from severe bupivacaine cardiac toxicity. The present studies were undertaken to determine if this method is similarly effective in a non-rodent model using a larger animal. Methods: Bupivacaine, 10 mg/kg, was administered intravenously over 10 seconds to fasted dogs under isoflurane general anesthesia. Resuscitation included 10 minutes of internal cardiac massage followed with either saline or 20% lipid infusion, administered as a 4-mL/kg bolus followed by continuous infusion at 0.5 mL/kg/min for 10 minutes. Electrocardiogram (EKG), arterial blood pressure (BP), and myocardial pH (pHm) and pO2 (pmO2) were continuously measured. Results: Survival after 10 minutes of unsuccessful cardiac massage was successful for all lipid-treated dogs (n = 6), but with no survivors in the saline controls (n = 6) (P < .01). Hemodynamics, PmO2, and pHm were improved during resuscitation with lipid compared with saline treatment in which dogs did not recover. Conclusions: We found that infusing a lipid emulsion during resuscitation from bupivacaine-induced cardiac toxicity substantially improved hemodynamics, pmO2, and pHm and increased survival in dogs. Reg Anesth Pain Med 2003;28:198-202.