Document Detail

Lipid emulsion improves recovery from bupivacaine-induced cardiac arrest, but not from ropivacaine- or mepivacaine-induced cardiac arrest.
MedLine Citation:
PMID:  19762764     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cardiac toxicity significantly correlates with the lipophilicity of local anesthetics (LAs). Recently, the infusion of lipid emulsions has been shown to be a promising approach to treat LA-induced cardiac arrest. As the postulated mechanism of action, the so-called "lipid sink" effect may depend on the lipophilicity of LAs. In this study, we investigated whether lipid effects differ with regard to the administered LAs. METHODS: In the isolated rat heart, cardiac arrest was induced by administration of equipotent doses of bupivacaine, ropivacaine, and mepivacaine, respectively, followed by cardiac perfusion with or without lipid emulsion (0.25 mL x kg(-1) x min(-1)). Subsequently, the times from the start of perfusion to return of first heart activity and to recovery of heart rate and rate-pressure product (to 90% of baseline values) were assessed. RESULTS: In all groups, lipid infusion had no effects on the time to the return of any cardiac activity. However, recovery times of heart rate and rate-pressure product (to 90% of baseline values) were significantly shorter with the administration of lipids in bupivacaine-induced cardiac toxicity, but not in ropivacaine- or mepivacaine-induced cardiac toxicity. CONCLUSIONS: These data show that the effects of lipid infusion on LA-induced cardiac arrest are strongly dependent on the administered LAs itself. We conclude that lipophilicity of LAs has a marked impact on the efficacy of lipid infusions to treat cardiac arrest induced by these drugs.
York A Zausig; Wolfgang Zink; Meike Keil; Barbara Sinner; Juergen Barwing; Christoph H R Wiese; Bernhard M Graf
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Publication Detail:
Type:  Comparative Study; In Vitro; Journal Article    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  109     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-09-18     Completed Date:  2009-10-01     Revised Date:  2010-05-27    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1323-6     Citation Subset:  AIM; IM    
University of Regensburg, Department of Anaesthesiology, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
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MeSH Terms
Amides / toxicity*
Anesthetics, Local / toxicity*
Antidotes / pharmacology*
Bupivacaine / toxicity*
Fat Emulsions, Intravenous / pharmacology*
Heart Arrest / chemically induced,  physiopathology,  therapy*
Heart Rate / drug effects
Mepivacaine / toxicity*
Rats, Wistar
Recovery of Function
Time Factors
Ventricular Function, Left / drug effects
Ventricular Pressure / drug effects
Reg. No./Substance:
0/Amides; 0/Anesthetics, Local; 0/Antidotes; 0/Fat Emulsions, Intravenous; 2180-92-9/Bupivacaine; 84057-95-4/ropivacaine; 96-88-8/Mepivacaine
Comment In:
Anesth Analg. 2010 Jun;110(6):1750-1; author reply 1751-2   [PMID:  20501817 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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