Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity.
OBJECTIVE
We previously demonstrated in rats that intravenous infusion of a lipid emulsion increases survival in resuscitation from severe bupivacaine cardiac toxicity. The present studies were undertaken to determine if this method is similarly effective in a non-rodent model using a larger animal.


METHODS
Bupivacaine, 10 mg/kg, was administered intravenously over 10 seconds to fasted dogs under isoflurane general anesthesia. Resuscitation included 10 minutes of internal cardiac massage followed with either saline or 20% lipid infusion, administered as a 4-mL/kg bolus followed by continuous infusion at 0.5 mL/kg/min for 10 minutes. Electrocardiogram (EKG), arterial blood pressure (BP), and myocardial pH (pHm) and pO2 (pmO2) were continuously measured.


RESULTS
Survival after 10 minutes of unsuccessful cardiac massage was successful for all lipid-treated dogs (n = 6), but with no survivors in the saline controls (n = 6) (P <.01). Hemodynamics, PmO2, and pHm were improved during resuscitation with lipid compared with saline treatment in which dogs did not recover.


CONCLUSIONS
We found that infusing a lipid emulsion during resuscitation from bupivacaine-induced cardiac toxicity substantially improved hemodynamics, pmO2, and pHm and increased survival in dogs.
Weinberg
Guy
G
Department of Anesthesiology, University of Illinois at Chicago College of Medicine, Chicago, Illinois 60612, USA. guyw@uic.edu
Ripper
Richard
R
Feinstein
Douglas L
DL
Hoffman
William
W
D000779:Anesthetics, Local / Q000009:adverse effects* / Q000633:toxicity*; D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000037:antagonists & inhibitors* / Q000633:toxicity*; D002245:Carbon Dioxide / Q000097:blood; D004285:Dogs; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D006323:Heart Arrest / Q000139:chemically induced / Q000517:prevention & control*; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006863:Hydrogen-Ion Concentration; D009200:Myocardial Contraction / Q000187:drug effects; D009206:Myocardium / Q000378:metabolism; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000187:drug effects
D000779:Anesthetics, Local; D005217:Fat Emulsions, Intravenous; D002245:Carbon Dioxide; D010100:Oxygen; D002045:Bupivacaine