Effect of lidocaine and bretylium on energy requirements for transthoracic defibrillation: Experimental studies

Kerber, Richard E.; Pandian, Natesa G.; Jensen, Susan R.; Constantin, Luis; Kieso, Robert A.; Melton, Jeffrey; Hunt, Michelle

doi:10.1016/s0735-1097(86)80512-5

Cited by 89 publications

(14 citation statements)

References 12 publications

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“…By contrast, hypnotic doses of pentobarbital cause an increase in TPR, whereby the influence on the cardiac function of the pig chiefly involves a reduction in both HR and diastolic blood pressure [17]. These observations might be due to pentobarbital's property of lowering the sensitivity of the heart to catecholamines [9,12]. It might thus be possible to maintain a sympathovagal balance by dosing the two drugs properly.…”

Section: Discussionmentioning

confidence: 99%

Combination anesthesia with ketamine and pentobarbital: a long-term porcine model

et al. 1999

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Anesthesia of the pig poses great problems for experimental animal-based research and particularly in shock research. In this study, five mechanically ventilated domestic pigs were given long-term anesthesia with a combination of ketamine plus pentobarbital. Circulatory parameters were recorded every 2 h via an arterial catheter placed in the right common carotid artery, a Swan-Gans thermodilution catheter (7F), that was placed in the pulmonary artery of the right middle-lobe in a wedge position through the external jugular vein, and another catheter in the internal jugular vein for measuring central venous pressure. Moreover, body weight, blood gases, pH, blood cells, electrolytes and serum enzymes were measured. Further serum traits as total protein and glucose and pathological alterations in different organs were recorded. The animals were observed for a period of 96 h and then killed painlessly. It was shown that pigs can survive 96-h anesthesia with the combination of ketamine and pentobarbital. Optimum, carefully controlled anesthesia did not impair the integrity of the regulatory mechanisms of circulation.

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Section: Discussionmentioning

confidence: 99%

Combination anesthesia with ketamine and pentobarbital: a long-term porcine model

et al. 1999

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“…In the Cox analysis, the second most powerful predictor less chance for benefit. Indeed, 13 55, and 58 and the present study), is being given at the time of operation. Also, because antiarrhythmic drugs appear to be important factors influencing surgical success, further studies are in order to identify the mechanisms by which they alter the defibrillation threshold.…”

Section: Reflections and Recommendations For Managementmentioning

confidence: 91%

Clinical characteristics and outcome of patients with high defibrillation thresholds. A multicenter study.

et al. 1992

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BACKGROUND Successful defibrillation by an implantable cardioverter-defibrillator (ICD) depends on its ability to deliver shocks that exceed the defibrillation threshold. This study was designed to identify clinical characteristics that may predict the finding of an elevated defibrillation threshold and to describe the outcome of patients with high defibrillation thresholds. METHODS AND RESULTS The records of 1,946 patients from 12 centers were screened to identify 90 patients (4.6%) with a defibrillation threshold greater than or equal to 25 J. Excluding three patients who received ICDs that delivered greater than 30 J, there were 81 men and six women with a mean age of 59.5 +/- 10.1 years, a mean left ventricular ejection fraction of 0.32 +/- 0.14, and a 76% prevalence of coronary artery disease. Sixty-one patients (70%) were receiving antiarrhythmic drugs, and 45 (52%) were receiving amiodarone. Seventy-one patients (82%) received an ICD. Death occurred in 27 patients--19 of the 71 (27%) with an ICD (eight arrhythmic), and eight of the 16 (50%) without an ICD (four arrhythmic). Actuarial survival for all patients at 5 years was 67%. Actuarial survival rates at 2 years for patients with and without an ICD were 81% and 36%, respectively (p = 0.0024). Actuarial survival at 5 years for the ICD patients was 73%; no patient without an ICD has lived longer than 32 months. Actuarial survival free of arrhythmic death in the ICD patients at 5 years was 84%. Although the only variable to predict survival was ICD implantation (p = 0.003), it is entirely possible that in this retrospective analysis, clinical selection decisions to implant or to not implant an ICD differentiated patients destined to have better or worse outcomes, respectively. CONCLUSIONS Antiarrhythmic drug use may be causally related to the finding of an elevated defibrillation threshold. When patients with high defibrillation thresholds receive an ICD, arrhythmic death remains an important risk (42% of deaths in these patients were arrhythmia related, with 16% actuarial incidence at 5 years). Vigorous testing to optimize patch location can potentially benefit patients by enhancing the margin of safety for effective defibrillation.

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“…Lidocaine is also often used to treat persistent ventricular fibrillation because the drug has been shown in some studies to prevent the emergence of ventricular fibrillation during the early hours of acute myocardial infarction.9 -Other studies, however, have shown that lidocaine increases defibrillation energy level requirements and is relatively ineffective in terminating ventricular tachyarrhythmias after they have been established. [12][13][14][15][16][17] Ventricular fibrillation persists after initial defibrillation attempts in 25-40% of patients discovered in cardiac arrest and may present a condition quite different from either acute myocardial infarction or experimental resuscitation, and thus may have dif-Methods The Seattle Emergency Medical System is a tiered response system. The first level of care is provided by firefighters.…”

Section: Effect Of Epinephrine and Lidocainementioning

confidence: 99%

Effect of epinephrine and lidocaine therapy on outcome after cardiac arrest due to ventricular fibrillation.

et al. 1990

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One hundred ninety-nine patients with out-of-hospital cardiac arrest persisted in ventricular fibrillation after the first defibrillation attempt and were then randomly assigned to receive either epinephrine or lidocaine before the next two shocks. The resulting electrocardiographic rhythms and outcomes for each group of patients were compared for each group and also compared with results during the prior 2 years, a period when similar patients primarily received sodium bicarbonate as initial adjunctive therapy. Asystole occurred after defibrillation with threefold frequency after repeated injection of lidocaine (15 of 59, 25%) compared with patients treated with epinephrine (four of 55, 7%) (p<0.02). There was no difference in the proportion of patients resuscitated after treatment with either lidocaine or epinephrine (51 of 106, 48% vs. 50 of 93, 54%) and in the proportion surviving (18, 19% vs. 21, 20%), respectively. Resuscitation (64% vs. 50%, p<0.005) but not survival rates (24% vs. 20%) were higher during the prior 2-year period in which initial adjunctive drug treatment for persistent ventricular fibrillation primarily consisted of a continuous infusion of sodium bicarbonate. The negative effect of lidocaine or epinephrine treatment was explained in part by their influence on delaying subsequent defibrillation attempts. Survival rates were highest (30%) in a subset of patients who received no drug therapy between shocks. We conclude that currently recommended doses of epinephrine and lidocaine are not useful for improving outcome in patients who persist in ventricular fibrillation. Lidocaine administration is commonly associated with asystole, and any possible attribute of initial adjunctive drug therapy is outweighed by its detrimental effect on delaying successive shocks for persistent ventricular fibrillation. (Circulation 1990;82:2027-2034

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Effect of lidocaine and bretylium on energy requirements for transthoracic defibrillation: Experimental studies

Cited by 89 publications

References 12 publications

Combination anesthesia with ketamine and pentobarbital: a long-term porcine model

Combination anesthesia with ketamine and pentobarbital: a long-term porcine model

Clinical characteristics and outcome of patients with high defibrillation thresholds. A multicenter study.

Effect of epinephrine and lidocaine therapy on outcome after cardiac arrest due to ventricular fibrillation.

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