title: Resuscitation from bupivacaine-induced asystole in rats: comparison of different cardioactive drugs.
abstract: The objective of this study was to compare the success of resuscitation attempts with different cardioactive drugs after bupivacaine-induced asystole. Saline, amrinone (1 mg/kg), dopamine (5 micrograms/kg), norepinephrine (2 micrograms/kg), epinephrine (10 micrograms/kg), or isoproterenol (1 microgram/kg) were tested. Sixty rats assigned to six treatment groups (n = 10/group) were lightly anesthetized (0.5% halothane, 70% N2O), paralyzed (doxacurium), and given bupivacaine intravenously at 4 mg.kg-1.min-1 until asystole. Five seconds later up to three treatment drug doses were given at 30-s intervals. Then external cardiac massage was instituted as needed. Spontaneous heartbeat was restored in all animals given norepinephrine or epinephrine. It was not restored in one saline-treated, one dopamine-treated, one isoproterenol-treated, and three amrinone-treated animals. The highest (best) arbitrary scores for overall resuscitation success were achieved with norepinephrine and the lowest with amrinone (P < 0.05). The incidence of ventricular arrhythmias after resuscitation was significantly higher (P < 0.05) in epinephrine- and isoproterenol-treated animals versus other animals. Cardiac rhythm disturbance disappeared within 20 min after successful resuscitation with norepinephrine. Amrinone was no more effective than saline in treating bupivacaine-induced asystole. A drug such as norepinephrine, which has both cardiostimulator (beta 1-receptor agonist) and peripheral vasoconstrictor (alpha 1-receptor agonist) activity, may be the drug of choice for treating asystole induced by bupivacaine.
authors.affiliation: Department of Anesthesiology, Texas Tech University Health Sciences Center, Lubbock 79430, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Heavner
authors.forename: M T
authors.initials: MT
authors.lastname: Pitkänen
authors.forename: B
authors.initials: B
authors.lastname: Shi
authors.forename: P H
authors.initials: PH
authors.lastname: Rosenberg
mesh_terms: D000676:Amrinone / Q000627:therapeutic use; D000818:Animals; D001794:Blood Pressure; D002045:Bupivacaine / Q000633:toxicity*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004298:Dopamine / Q000627:therapeutic use; D004562:Electrocardiography; D004837:Epinephrine / Q000494:pharmacology; D006323:Heart Arrest / Q000139:chemically induced / Q000188:drug therapy* / Q000503:physiopathology; D007545:Isoproterenol / Q000494:pharmacology; D008297:Male; D009638:Norepinephrine / Q000494:pharmacology; D051381:Rats; D017207:Rats, Sprague-Dawley; D012151:Resuscitation
chemical_list: D002316:Cardiotonic Agents; D000676:Amrinone; D007545:Isoproterenol; D004298:Dopamine; D009638:Norepinephrine; D002045:Bupivacaine; D004837:Epinephrine