title: Insulin reverses bupivacaine-induced cardiac depression in dogs.
abstract: We tested the hypothesis that an insulin infusion would effectively treat bupivacaine-induced cardiac depression in dogs. In 24 mongrel dogs anesthetized with pentobarbital (5 mgkg(-1)h(-1), IV), 0.5% bupivacaine was administrated at a rate of 0.5 mgkg(-1)min(-1) until the mixed venous oxygen saturation decreased to 60% or less. The bupivacaine infusion induced a decrease in mean arterial pressure, cardiac output, and heart rate. The dogs were randomly assigned to one of four groups after the end of bupivacaine infusion. The Control (C, n = 6) and Glucose (G, n = 6) groups received an IV infusion of normal saline (2 mL/kg) and glucose (2 mL/kg of 50% dextrose in water) for 15 min, respectively. The Insulin-Glucose (IG, n = 6) group received an IV bolus of regular insulin (1 U/kg), plus a glucose infusion (2 mL/kg of 50% dextrose in water) for 15 min. The Insulin-Glucose-Potassium (IGK, n = 6) group received the same dose of insulin and glucose as the IG group, plus potassium (1-3 mEqkg(-1)h(-1)). Mean arterial pressure, cardiac output, heart rate, and mixed venous oxygen saturation recovered toward baseline level more rapidly in the IG and IGK groups than in the C group (within 5 min versus more than 20 min). These results suggest that the infusion of insulin and glucose might reverse bupivacaine-induced cardiac depression in dogs.
  
  
  CONCLUSIONS
  We found that insulin and glucose rapidly reversed hemodynamic abnormality in dogs with bupivacaine-induced cardiac depression. This study implies a possible clinical application of insulin treatment for bupivacaine-induced cardiac depression.
authors.affiliation: Department of Anesthesiology, Samsung Medical Center, Sungkyunkwan University School of Medicine. College of Medicine, Seoul National University, Seoul, Korea.
authors.forename: H S
authors.initials: HS
authors.lastname: Cho
authors.forename: J J
authors.initials: JJ
authors.lastname: Lee
authors.forename: I S
authors.initials: IS
authors.lastname: Chung
authors.forename: B S
authors.initials: BS
authors.lastname: Shin
authors.forename: J A
authors.initials: JA
authors.lastname: Kim
authors.forename: K H
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000779:Anesthetics, Local / Q000633:toxicity*; D000818:Animals; D002045:Bupivacaine / Q000633:toxicity*; D003864:Depression, Chemical; D004285:Dogs; D004562:Electrocardiography / Q000187:drug effects; D004573:Electrolytes / Q000097:blood; D005947:Glucose / Q000008:administration & dosage / Q000494:pharmacology; D006321:Heart / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000494:pharmacology*; D011188:Potassium / Q000008:administration & dosage / Q000494:pharmacology
chemical_list: D000779:Anesthetics, Local; D004573:Electrolytes; D007328:Insulin; D005947:Glucose; D011188:Potassium; D002045:Bupivacaine