Epinephrine and Phenylephrine Increase Cardiorespiratory Toxicity of Intravenously Administered Bupivacaine in Rats

Kambam, J. R.; Kinney, W W; Matsuda, F.; Wright, W.; Holaday, Duncan A.

doi:10.1213/00000539-199005000-00013

Cited by 18 publications

(4 citation statements)

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“…It does not, however, protect against bupivacaine-induced cardiotoxicity 15 or even potentiate toxicity. 16 This is explained in part by its arrhythmogenic property. Kasten and Martin 17 showed that bretylium, which is an antifibrillatory agent, but not lidocaine, effectively corrected bupivacaine-induced cardiotoxicity.…”

Section: Discussionmentioning

confidence: 99%

Lidocaine increases the ventricular fibrillation threshold during bupivacaine-induced cardiotoxicity in pigs

Fujita

Endoh

Yasukawa

et al. 1998

British Journal of Anaesthesia

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Ventricular fibrillation (VF) is a cause of death in bupivacaine-induced cardiovascular toxicity. We have examined the therapeutic effects of lidocaine on the threshold for bupivacaine-induced VF in in situ beating swine hearts. Twenty-four animals were allocated to one of three groups: 0.25% bupivacaine, 1% lidocaine or 0.25% bupivacaine with 1% lidocaine were infused into the left anterior descending coronary artery in increasing doses of 0, 1, 2, 4, 8 and 16 ml h-1 for 15 min, respectively. ECG and haemodynamic variables were monitored continuously during infusion. Regional myocardial function in the area supplied by the left anterior descending coronary artery was assessed using the sonomicrometry technique. VF did not occur in the lidocaine group. VF developed at higher infusion rates in animals given bupivacaine with lidocaine (in one animal at an infusion rate of 8 ml h-1 and in seven at 16 ml h-1) compared with animals given bupivacaine alone (in one at an infusion rate of 4 and in seven at 8 ml h-1). Although regional myocardial function decreased with increases in the infusion rate in each group, the depressant effects of the bupivacaine solution (medial inhibitory infusion rate of systolic shortening: IR50 = 2.43 (0.43) ml h-1) were significantly greater than those of the lidocaine solution (IR50 = 5.83 (0.87) ml h-1), but did not differ from those of the bupivacaine with lidocaine solution (IR50 = 3.54 (0.56) ml h-1). This study indicates that a combination of lidocaine and bupivacaine increased the threshold for bupivacaine-induced VF without further depressing myocardial contractility.

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Section: Discussionmentioning

confidence: 99%

Lidocaine increases the ventricular fibrillation threshold during bupivacaine-induced cardiotoxicity in pigs

Fujita

Endoh

Yasukawa

et al. 1998

British Journal of Anaesthesia

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“…Ventricular arrhythmias are associated with acute bupivacaine toxicity, in both isolated cardiac preparations, intact animals and man [12][13][14]. Increased concentrations of circulating plasma catecholamines [15,16] and decreased plasma concentrations of potassium [17] appear to facilitate bupivacaineinduced arrhythmias. Arrhythmias were not the predominant cause of death in our study.…”

Section: Discussionmentioning

confidence: 99%

Enhancement of Bupivacaine Toxicity by Diltiazem in Anaesthetized Dogs †

Finegan

Whiting

Tam

et al. 1992

British Journal of Anaesthesia

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We have studied the cardiovascular effects of graded doses of bupivacaine in the absence or presence of clinical concentrations (approximately 250 micrograms litre-1) of diltiazem in fentanyl-pentobarbitone anaesthetized dogs. Bupivacaine was given, increasing in a stepwise manner, as a loading dose (200, 400 or 600 micrograms kg-1) followed by a 30-min i.v. infusion (25, 100 or 200 micrograms kg-1 min-1, respectively). Thereafter, bupivacaine was infused at 400 micrograms kg-1 min-1 until each animal died. Group A (n = 7) received bupivacaine, group B (n = 5) diltiazem (400 micrograms kg-1 followed by 12 micrograms kg-1 min-1) and group C (n = 7) received diltiazem followed by bupivacaine given as in group A. Lethal plasma concentrations of bupivacaine were significantly smaller (P < 0.01) in group C (7.1 (SEM 0.7) vs 12.6 (1.5) mg litre-1). Bupivacaine produced similar decreases in cardiac index, left ventricular (LV) segmental work and the first derivative of LV pressure (LV dP/dt) in the absence and presence of diltiazem. In group A, bupivacaine increased systemic vascular resistance index (SVRI) and thus mean arterial pressure (MAP) was maintained. In group C, SVRI, reduced by diltiazem per se, did not increase in response to bupivacaine, so MAP was not maintained. Death resulted from a progressive decrease in cardiac contractility and MAP. Plasma concentrations of bupivacaine attained at the three doses were similar in the absence and presence of diltiazem. This study has shown that the toxicity of bupivacaine was increased approximately two-fold by diltiazem.

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“…Adrenaline however, increases the myocardial dysfunction caused by bupivacaine overdose by increasing oxygen demand and reentry of arrhythmic cycles. 24 Bupivacaine precipitates rapidly when it is mixed with sodium bicarbonate as it gets less water soluble with an increase in pH. This leads to increased systemic absorption and toxicity.…”

Section: Lidocaine Ideal For Tumescent Liposuctionmentioning

confidence: 99%

Tumescent anaesthesia for liposuction surgery—A review

Goyal

2021

Dermatological Reviews

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Liposuction surgery has traditionally been performed under systemic anaesthesia since its invention in mid 1970s. The concept of liposuction under tumescent local anaesthesia by Jeffrey Klein MD, USA, using a dilute mixture of lidocaine, adrenaline and sodium bicarbonate in normal saline has radically modified the outcomes of the procedure making it very safe and at the same time effective to conduct the procedure. Tumescent anaesthesia is very well accepted by dermatologists performing liposuction around the world. Not a single death has been recorded when the principles of tumescent anaesthesia have been followed strictly during liposuction.The article is a review of different types of anaesthesia and issues specific to their use in liposuction surgery. It is the end result of an extensive search and compilation of facts from scientific publications (articles and chapters form textbooks) in the dermatologic, plastic surgery, pharmacology and anaesthesia fields.

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Epinephrine and Phenylephrine Increase Cardiorespiratory Toxicity of Intravenously Administered Bupivacaine in Rats

Cited by 18 publications

References 0 publications

Lidocaine increases the ventricular fibrillation threshold during bupivacaine-induced cardiotoxicity in pigs

Lidocaine increases the ventricular fibrillation threshold during bupivacaine-induced cardiotoxicity in pigs

Enhancement of Bupivacaine Toxicity by Diltiazem in Anaesthetized Dogs †

Tumescent anaesthesia for liposuction surgery—A review

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