Ropivacaine combined with various anti-arrhythmic drugs results in mild alterations in myocardial contractility in pigs.
OBJECTIVE
The present study was undertaken following the observation of a marked decrease in myocardial contractility after ropivacaine in a patient on amiodarone, in order to investigate the cardiovascular effects of combining ropivacaine with anti-arrhythmic drugs (AARD).


METHODS
Anesthetized domestic pigs were treated with disopyramide, flecainide, atenolol, amiodarone, diltiazem or nicardipine at a dose leading to blood levels obtained in treated patients, then received 1 mg*kg(-1) ropivacaine. Blood pressure (BP), left venticular (LV) dP/dt max, sinus heart rate, and intraventricular conduction time were measured before and following the administration of AARD, and following ropivacaine at different time points.


RESULTS
All tested AARD induced the expected hemodynamic and electrophysiologic effects. Following ropivacaine, a 20 to 35% decrease in LV dP/dt max of prolonged duration was observed with amiodarone only. A brief 10 to 20% decrease in mean BP was observed in all animals, except those treated with nicardipine who sustained an important and prolonged decrease in BP. All other variables were not significantly affected.


CONCLUSIONS
The combination of ropivacaine with AARD was always associated with a slight drop in LV dP/dt max. The effect on mean BP was slight, except with nicardipine. Clinicians should be aware of the interactions of ropivacaine with AARD, especially amiodarone and nicardipine.
Barel
Cécile
C
Laboratory of Medical Pharmacology, Claude Bernard University, Lyon, France.
Belkhiria
Majda
M
Bui-Xuan
Bernard
B
Descotes
Jacques
J
Chevalier
Philippe
P
Gagnieu
Marie-Claude
MC
Arnal
Florence
F
Tsibiribi
Panayota
P
Timour
Quadiri
Q
D000577:Amides / Q000494:pharmacology*; D000638:Amiodarone / Q000494:pharmacology; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000494:pharmacology*; D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology; D004206:Disopyramide / Q000494:pharmacology; D004347:Drug Interactions; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D009200:Myocardial Contraction / Q000187:drug effects*; D011446:Prospective Studies; D011897:Random Allocation; D000077212:Ropivacaine; D013552:Swine
D000577:Amides; D000779:Anesthetics, Local; D000889:Anti-Arrhythmia Agents; D000077212:Ropivacaine; D004206:Disopyramide; D000638:Amiodarone