The Comparative Effects of Lipid, Epinephrine, and Their Combination in the Reversal of Bupivacaine-Induced Asystole in the Isolated Rat Heart

Liu, Le; Xia, Yun; Ying, Chen; Wang, Quanguang; Shi, Tong; Wang, Fangyan; Small, Robert H.; Xu, Xuzhong

doi:10.1213/ane.0b013e3182166a0a

Cited by 23 publications

(20 citation statements)

References 17 publications

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“…This finding is consistent with our previous work in the isolated rat heart model of bupivacaine toxicity, wherein lipid emulsion combined with epinephrine produced superior coronary flow and RPP value than resuscitation with lipid emulsion alone. 27 The results in experiment B indicate that both treatments resulted in a sharp decline in total myocardial bupivacaine concentration during the initial 30 min after asystole, a time period during which cardiac tissue bupivacaine content decreased by 90.4% after LCT emulsion treatment and by 93.0% after LCT/MCT emulsion treatment. Overall, the similar measurements at 0 min and 30 min suggested they may exert their curative effects in a 30-min time period.…”

Section: Discussionmentioning

confidence: 84%

Lipid Resuscitation of Bupivacaine Toxicity

Li¹,

Xia

Dong

et al. 2011

Anesthesiology

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Background:The superiority of Intralipid, a long-chain triglyceride (LCT) emulsion versus Lipovenoes, a long-and medium-chain triglyceride (LCT/MCT) emulsion, in reversing local anesthetic-induced cardiac arrest is poorly defined and needs to be determined. Methods:The study included two parts: in experiment A, bupivacaine (20 mg/kg) was injected to produce asystole. Either Intralipid 20% (LCT group, n ϭ 30) or Lipovenoes 20% (LCT/MCT group, n ϭ 30) with epinephrine was infused immediately. Return of spontaneous circulation and recurrence of asystole after resuscitation were recorded. In experiment B, 80 rats using the same model and resuscitation protocol were divided into 10 groups: LCT 0 , LCT 15 , LCT 30, LCT 60 , and LCT 120 and LCT/MCT 0 , LCT/MCT 15 , LCT/ MCT 30 , LCT/MCT 60 , and LCT/MCT 120 (n ϭ 8 each; the subscripts represent respective observation period). LCT 15 -LCT 120 and LCT/MCT 15 -LCT/MCT 120 groups received Intralipid 20% or Lipovenoes 20%, respectively. Plasma and myocardial bupivacaine and triglyceride concentrations, as well as myocardial bioenergetics, were determined.

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Section: Discussionmentioning

confidence: 84%

Lipid Resuscitation of Bupivacaine Toxicity

Li¹,

Xia

Dong

et al. 2011

Anesthesiology

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“…Moreover, a single dose of adrenaline at C10 lg/kg significantly impaired the efficacy of lipid resuscitation despite a rapid increase of rate pressure product early in the resuscitation [11]. Adding adrenaline to lipid emulsion induced ventricular tachycardia and did not improve recovery time from bupivacaineinduced asystole in an isolated rat heart [22]. Lipid emulsion was also superior to vasopressin for resuscitation of bupivacaine-induced cardiac arrest in a rat model [14].…”

Section: Use Of Adrenaline In Resuscitation For Local Anesthetic Overmentioning

confidence: 94%

Lipid resuscitation: development in basic research and application to clinical practice

Oda

2013

J Anesth

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“…The Langendorff isolated heart perfusion model was used. This consisted of a balanced perfusion with K-H solution for 25 min (baseline time, or time zero, was designated as Tb), and a continuous infusion of 100 μmol/L bupivacaine (Bupivacaine hydrochloride powder, batch number 100959032, Sigmar, USA) until asystole had been induced for 3 minutes [14,15]. The hearts in the seven groups were then perfused with a K-H solution containing a 2% lipid emulsion (20% Intralipid, Huarui Pharmaceutical Co., Ltd., Suzhou, China), and 40, 60, 80, 100, 120, 140, or 160 μmol/L bupivacaine, respectively.…”

Section: Methodsmentioning

confidence: 99%

Measurement of the efficacy of 2% lipid in reversing bupivacaine- induced asystole in isolated rat hearts

et al. 2014

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BackgroundThe reversal efficacy of 2% lipid emulsion in cardiac asystole induced by different concentrations of bupivacaine is poorly defined and needs to be determined.MethodsForty-two male Sprague–Dawley rats were randomly divided into seven groups: B40, B60, B80, B100, B120, B140 and B160, n = 6. The Langendorff isolated heart perfusion model was used, which consisted of a balanced perfusion with Krebs-Henseleit solution for 25 minutes and a continuous infusion of 100 μmol/L bupivacaine until asystole had been induced for 3 minutes. The hearts in the seven groups were perfused with Krebs-Henseleit solution containing a 2% lipid emulsion, and 40, 60, 80, 100, 120, 140 or 160 μmol/L bupivacaine, respectively. Cardiac recovery was defined as a spontaneous and regular rhythm with a rate-pressure product > 10% of the baseline value for more than 1 minute. Our primary outcome was the rate-pressure product 25 minutes after cardiac recovery. Other cardiac function parameters were also recorded.ResultsAll groups demonstrated cardiac recovery. During the recovery phase, heart rate, rate-pressure product, the maximum left ventricular pressure rise and decline in heart rate in the B120-B160 groups was significantly lower than those in the B40-B80 groups (P < 0.05). The concentration of bupivacaine and the reversal effects of a 2% lipid emulsion showed a typical transoid S-shaped curve, R2 = 0.9983, IC50 value was 102.5 μmol/L (95% CI: 92.44 - 113.6).ConclusionsThere is a concentration-response relationship between the concentrations of bupivacaine and the reversal effects of 2% lipid emulsion.

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The Comparative Effects of Lipid, Epinephrine, and Their Combination in the Reversal of Bupivacaine-Induced Asystole in the Isolated Rat Heart

Abstract: Lipid combined with epinephrine resulted in better recovery of cardiac function than either drug alone in reversal of bupivacaine-induced asystole in the isolated rat heart model.

Cited by 23 publications

References 17 publications

Lipid Resuscitation of Bupivacaine Toxicity

Lipid Resuscitation of Bupivacaine Toxicity

Lipid resuscitation: development in basic research and application to clinical practice

Measurement of the efficacy of 2% lipid in reversing bupivacaine- induced asystole in isolated rat hearts

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