Abstract
Purpose
To investigate changes of continuous mixed venous oxygen saturation (cSvO2) and mean arterial blood pressure (MBP) in dogs with bupivacaine-induced cardiac depression.
Methods
Bupivacaine was infused into pentobarbital-anesthetized mongrel dogs (n = 8) at a rate of 0.5 mg·kg−1min·−1 until the MBP was 40 mmHg or less (end of bupivacaine infusion; BIE). The infusion time was divided into the early period, first 30 min of bupivacaine infusion and the late period, which was from 30 min of bupivacaine infusion until BIE. cSvO2 was monitored using a fibreoptic pulmonary artery catheter, and MBP and cardiac output (CO) were measured every ten minutes after the initiation of bupivacaine infusion. Arterial blood gas, serum electrolyte and bupivacaine concentration were measured simultaneously. The relationships between CO and cSvO2, and of COvs MBP were compared by regression analysis in the early and late periods.
Results
The Pearson’s correlation coefficients between CO and cSvO2 were 0.782 (P = 2.1 × 10−7) in the early period and 0.824 (P = 1.3 × 10−6) in the late period. The correlation coefficients between CO and MBP were 0.0 19 (P = 0.921) in the early period and 0.799 (P = 4.8 × 10−6) in the late period.
Conclusions
CSvO2, but not MBP is associated with CO changes in bupivacaine-induced cardiac depression during the early period of bupivacaine intoxication. Decrease of MBP with low cSvO2 observed during the late period might imply severe cardiac depression induced by bupivacaine infusion.
Résumé
Objectif
Examiner les modifications de ia saturation continue en oxygène du sang veineux mêié (ScO2v) et de la tension artérielle moyenne (TAM) chez des chiens qui présentent une dépression cardiaque induite par ia bupivacaïne.
Méthode
La bupivacaïne a été administrée chez des chiens de race commune (n = 8), anesthésiés au pentobarbital, selon un débit de 0,5 mg·kg−1·min−1 jusqu’à ce que la TAM soit de 40 mmHg ou moins (fin de ia perfusion de bupivacaïne; FPB). Le temps de perfusion a été divisé en une période précoce pour tes 30 premières min et tardive, à partir de 30 min jusqu’à la FPB. La ScO2v a été enregistrée avec un cathéter artériel pulmonaire fibroscopique. La TAM et te débit cardiaque (DC) ont été mesurés toutes les dix minutes après ie début de ia perfusion de bupivacaïne. La gazométrie du sang artériel, la concentration sérique d’électrolytes et de bupivacaïne ont été mesurées simultanément. La relation entre le CO et la ScO2v, et entre le CO et la TAM a été comparée par une analyse de régression pendant les deux périodes de perfusion déterminées.
Résultats
Les coefficients de corrélation de Pearson entre ie CO et la ScO2v ont été de 0,782 (P = 2,1 × 10−7) pendant la période précoce de la perfusion et de 0,824 (P = 1,3 × 10−6) pendant la période tardive. Les coefficients de corrélation entre le CO et la TAM ont été de 0,019 (P = 0,921) pendant la période précoce et de 0,799 (P = 4,8 × 10−6) pendant la période tardive.
Conclusion
La ScO2v, mais non la TAM, est associée aux variations de CO de la dépression cardiaque induite par la bupivacaïne pendant la période précoce de l’intoxication à la bupivacaïne. Une baisse de la TAM, accompagnée d’une faible ScO2v, observée pendant la période tardive, peut correspondre à une dépression cardiaque sévère induite par la perfusion de bupivacaïne.
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References
Clarkson CW, Hondeghem LM. Mechanism for bupivacaine depression of cardiac conduction: fast block of sodium channels during the action potential with slow recovery from block during diastole. Anesthesiology 1985; 62: 396–405.
Castle NA. Bupivacaine inhibits the transient outward K+ current but not the inward rectifier in rat ventricular myocytes. J Pharmacol Exp Ther 1990; 255: 1038–46.
Lynch C. Depression of myocardial contractility in vitro by bupivacaine, etidocaine, and lidocaine. Anesth Analg 1986; 65: 551–9.
Long WB, Rosenblum S, Grady LP. Successful resuscitation of bupivacaine-induced cardiac arrest using cardiopulmonary bypass. Anesth Analg 1989; 69: 403–6.
Feldman HS, Arthur GR, Pitkanen M, Hurley R, Doucette AM, Covino BG. Treatment of acute systemic toxicity after the rapid intravenous injection of ropivacaine and bupivacaine in the conscious dog. Anesth Analg 1991; 73: 373–84.
Scott DB, Lee A, Fagan D, Bowler GM, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989; 69: 563–9.
Knudsen K, Beckman Suurkula M, Blomberg S, Sjovall J, Evardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 1997; 78: 507–14.
Leach RM, Treacher DF. The relationship between oxygen delivery and consumption. Dis Mon 1994; 40: 301–68.
Shibutani K, Komatsu T, Kubal K, Sanchala V, Kumar V, Bizzarri DV. Critical level of oxygen delivery in anesthetized man. Crit Care Med 1983; 11: 640–3.
Ammar AD. Postoperative epidural analgesia following abdominal aortic surgery: do the benefits justify the costs? Ann Vasc Surg 1998; 12: 359–63.
Seeling W, Ahnefeld FW, Rosenberg G, Heinrich H, Spilker D. Aortofemoral bifurcation bypass-effect of anesthesia procedure (NLA, thoracic continuous catheter peridural anesthesia) on circulation, respiration and metabolism. Intraoperative circulatory reactions (German). Anaesthesist 1985; 34: 217–28.
Stone WM, Larson JS, Young M, Weaver AL, Lunn JJ. Early extubation after abdominal aortic reconstruction. J Cardiothorac Vasc Anesth 1998;12: 174–6.
Kessler P, Neidhart G, Bremerich DH, et al. High thoracic epidural anesthesia for coronary artery bypass grafting using two different surgical approaches in conscious patients. Anesth Analg 2002; 95: 791–7.
Tanaka K, Harada T, Dan K. Low-dose thoracic epidural anesthesia induces discrete thoracic anesthesia without reduction in cardiac output. Reg Anesth 1991; 16: 318–21.
Van de Water A, Verheyen J, Xhonneux R, Reneman RS. An improved method to correct the QT interval of electrocardiogram for changes in heart rate. J Pharmacol Methods 1989; 22: 207–17.
Rao V, Lvanov J, Weisel RD, Cohen G, Borger MA, Mickle DA. Lactate release during reperfusion predicts low cardiac output syndrome after coronary bypass surgery. Ann Thorac Surg 2001; 71: 1925–30.
Gudipati CV, Weil MH, Bisera J, Deshmukh HG, Rackow EC. Expired carbon dioxide: a noninvasive monitor of cardiopulmonary resuscitation. Circulation 1988; 77: 234–9.
Morrison SG, Dominguez JJ, Frascarolo P, Reiz S. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and ropivacaine in anesthetized swine. Anesth Analg 2000; 90: 1308–14.
Timour Q Freysz M, Mazze R, Couzon P, Bertix L, Faucon G. Enhancement by hyponatremia and hyperkalemia of ventricular conduction and rhythm disorders caused by bupivacaine. Anesthesiology 1990; 72: 1051–6.
Gould DB, Aldrete JA. Bupivacaine cardiotoxicity in a patient with renal failure. Acta Anaesthesiol Scand 1983; 27: 18–21.
Cho HS, Lee JJ, Chung LS, Shin BS, Kim JA, Lee KH. Insulin reverses bupivacaine-induced cardiac depression in dogs. Anesth Analg 2000; 91: 1096–102.
Saitoh K, Hirabayashi Y, Shimizu R, Fukuda H. Amrinone is superior to epinephrine in reversing bupivacaine-induced cardiovascular depression in sevofluraneanesthetized dogs. Anesthesiology 1995; 83: 127–33.
Jorfeldt L, Lofstrom B, Pernow B, Persson B, Wahren J, Widman B. The effect of local anesthetics on the central circulation and respiration in man and dog. Acta Anaesthesiol Scand 1968; 12: 153–69.
Edmunds NJ, Marshall JM. Vasodilatation, oxygen delivery and oxygen consumption in rat hindlimb during systemic hypoxia: role sof nitric oxide. J Physiol 2001; 532: 251–9.
Otter D, Austin C. Mechanisms of hypoxic vasodilatation of isolated rat mesenteric arteries a comparison with metabolic inhibition. J Physiol 1999; 516: 249–59.
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This article was supported by a grant of the Seoul National University (00-3-3-48).
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Kim, JT., Rhee, KY., Bahk, JH. et al. Continuous mixed venous oxygen saturation, not mean blood pressure, is associated with early bupivacaine cardiotoxicity in dogs. Can J Anesth 50, 376–381 (2003). https://doi.org/10.1007/BF03021035
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DOI: https://doi.org/10.1007/BF03021035