A Comparison of the Combination of Epinephrine and Vasopressin with Lipid Emulsion in a Porcine Model of Asphyxial Cardiac Arrest After Intravenous Injection of Bupivacaine

Mayr, Viktoria D.; Mitterschiffthaler, Lukas; Neurauter, Andreas; Gritsch, Christian; Wenzel, Volker; Müller, T; Luckner, Günter; Lindner, Karl H.; Strohmenger, Hans-Ulrich

doi:10.1213/01.ane.0000278866.01963.79

Cited by 88 publications

(67 citation statements)

References 24 publications

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“…18,19 The incidence of systemic toxicity from local anesthetics appears to be decreasing with the use of safer local anesthetics 20,21 and the widespread introduction of procedural safety. 20 Since dextromethorphan and dextrorphan are better tolerated systemically than bupivacaine in this animal model, these drugs should be investigated further as possible useful local anesthetics in the clinical setting.…”

Section: áMinmentioning

confidence: 99%

Systemic dextromethorphan and dextrorphan are less toxic in rats than bupivacaine at equianesthetic doses

Chen

Wang

Liu

et al. 2010

Can J Anesth/J Can Anesth

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Purpose Dextrorphan, a major metabolite of dextromethorphan, produces the duration of spinal and cutaneous anesthesia similar to bupivacaine. The purpose of this study was to test the central nervous system and cardiovascular toxicity of bupivacaine, dextromethorphan, and dextrorphan. Methods First, dose-response curves for dextromethorphan, dextrorphan, and bupivacaine (n = 8 at each testing point) were determined for cutaneous analgesia on the rat back, and equipotent doses were calculated. Next, during continuous intravenous infusion of equipotent doses of bupivacaine, dextromethorphan, and dextrorphan (n = 8 in each group), we observed the time to seizure, apnea, and complete cardiac arrest. A saline group (n = 7) was used for comparison. Mean arterial blood pressure (MAP), heart rate (HR), stroke volume (SV), and cardiac output (CO) were also monitored. Results Bupivacaine, dextromethorphan, and dextrorphan produced dose-dependent cutaneous anesthesia. A longer duration of equipotent infusion doses was required to produce seizures in the dextromethorphan group (10.6 ± 1.3 min) than in the bupivacaine group (7.6 ± 2.1 min) (P = 0.005). Dextrorphan did not produce any seizures. Compared with bupivacaine, time to apnea and complete cardiac arrest was longer with dextrorphan (P \ 0.001) and with dextromethorphan (P = 0.001). Cardiovascular collapse, defined as a decline in MAP, HR, CO, and SV, was slower in the dextromethorphan and dextrorphan groups than in the bupivacaine group (P \ 0.001 for both comparisons). Conclusion At equipotent doses for local anesthesia, dextromethorphan and dextrorphan were less likely than bupivacaine to induce central nervous system and cardiovascular toxicity. RésuméObjectif Le dextrorphane, un me´tabolite majeur du dextrome´thorphane, produit une anesthe´sie rachidienne et cutane´e d'une dure´e similaire a`la bupivacaı¨ne. L'objectif de cette e´tude consistait a`e´valuer la toxicite´de la bupivacaı¨ne, du dextrome´thorphane et du dextrorphane sur le syste`me nerveux central et le syste`me cardiovasculaire. Méthode Tout d'abord, les courbes dose-re´ponse du dextrome´thorphane, du dextrorphane et de la bupivacaı¨ne (n = 8 pour chaque essai) ont e´te´de´termine´es pour l'analge´sie cutane´e sur le dos du rat, et des doses Y.W. Chen and Y.C. Chen contributed equally to this study.

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Section: áMinmentioning

confidence: 99%

Systemic dextromethorphan and dextrorphan are less toxic in rats than bupivacaine at equianesthetic doses

Chen

Wang

Liu

et al. 2010

Can J Anesth/J Can Anesth

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“…68,69 This approach has support from animal experiments. 70,71 2. Use of lipid rescue is effective and superior to vasopressor therapy in local anaesthetic toxicity.…”

Section: The Use Of Propofol For Lipid Rescuementioning

confidence: 99%

“…Mayr and colleagues observed that vasopressin or adrenaline or a combination of the two was successful while lipid emulsion alone was uniformly unsuccessful in effecting resuscitation in a porcine model of bupivacaine cardiotoxicity. 71 The explanation offered for the divergent successes of lipid versus vasopressor therapy focussed on study design. Mayr and colleagues introduced a period of apnoea after bupivacaine administration while in the Weinberg and Di Gregorio 66 studies hypoxia and delay in resuscitation were avoided.…”

Section: The Use Of Propofol For Lipid Rescuementioning

confidence: 99%

Lipid rescue: the use of lipid emulsions to treat local anaesthetic toxicity

Kruger

Marwick

Levin

2009

Southern African Journal of Anaesthesia and Analgesia

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“…Due to their size, pigs better mimic the CPR-related aspects of drowning resuscitation and ICU care is feasible [234][235][236][237]. However, neuropathological targets and long-term outcome are not well defined.…”

Section: Pig Aca Modelsmentioning

confidence: 99%

Brain Resuscitation in the Drowning Victim

Warner

Knape

2006

Handbook on Drowning

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. This manuscript is dedicated to the memory of Peter Safar, M.D. Peter Safar combined genius, incredible purpose, elegance, and humanism to move the collective fields of acute medicine to a new level. His work in resuscitation medicine, critical care, anesthesiology, emergency medicine, and disaster medicine saved countless lives. As a mentor he taught us a great deal. Peter left us with an important message-in both clinical care and research: namely, to always ask, "what is your intervention or research doing for the patient?" Whether physician or scientist, it is a critical message never to forget.Portions of this manuscript are being reproduced in the Handbook of Drowning. Bierens JJ (ed.). Springer, 2nd Edition. NIH Public Access AbstractDrowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidence-based consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32-34 °C) considered. Arterial hypotension/hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating nonconvulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brain-oriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific postresuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/ reperfusion strategies, therapeutic hypothermia, neuroprotection, neurorehabilitation, and consideration of drowning in advances made in treatment of other central nervous system disorders.

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A Comparison of the Combination of Epinephrine and Vasopressin with Lipid Emulsion in a Porcine Model of Asphyxial Cardiac Arrest After Intravenous Injection of Bupivacaine

Abstract: In this model of a bupivacaine-induced cardiac arrest, the vasopressor combination of vasopressin and epinephrine compared with lipid emulsion resulted in higher coronary perfusion pressure during CPR and survival rates.

Cited by 88 publications

References 24 publications

Systemic dextromethorphan and dextrorphan are less toxic in rats than bupivacaine at equianesthetic doses

Systemic dextromethorphan and dextrorphan are less toxic in rats than bupivacaine at equianesthetic doses

Lipid rescue: the use of lipid emulsions to treat local anaesthetic toxicity

Brain Resuscitation in the Drowning Victim

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