The efficacy of nicorandil, calcium chloride and nitroglycerin in treatment of ropivacaine-induced cardiotoxicity.
OBJECTIVE
The amide-linked local anaesthetics, bupivacaine and ropivacaine, can cause depression of cardiac contractility and dysrhythmias. In a previous study, we observed decreased contractility and ST segment depression following ropivacaine administration in anaesthetized dogs. The efficacy of intravenous (i.v.) and intracoronary nicorandil (30 and 100 microg kg(-1)), i.v. nitroglycerin (glyceryl trinitrate) (5 microg kg(-1)) and calcium chloride (1, 2 and 4 mmol) in reversing the cardiotoxic effects of intracoronary ropivacaine were studied following the administration of intracoronary ropivacaine.


METHODS
Six dogs were studied. The dogs were anaesthetized with i.v. pentobarbital (30 mg kg(-1)). A left-sided thoracotomy was performed and the left circumflex coronary was cannulated. For each dog, the dose of ropivacaine was identified, which produced measurable cardiotoxicity. In each case, ropivacaine was followed by one of the three resuscitation drugs. The effects of each resuscitation drug on ST segments and left ventricular contractility (dP/dt) produced by ropivacaine alone were compared with those produced by ropivacaine followed by each of the three resuscitation drugs using Fisher's exact test.


RESULTS
The doses of ropivacaine required to produce depression of left ventricular dP/dt and ST segments ranged from 1 to 8 mg. Ropivacaine-induced depression of left ventricular contractility (dP/dt) was more rapidly and completely reversed by calcium chloride than by either nitroglycerin or nicorandil (P = 0.008).


CONCLUSIONS
Calcium chloride may be effective in the treatment of inadvertent intravascular administration of amide local anaesthetic agents.
Porter
J M
JM
University College Cork, Department of Anaesthesia and Intensive Care Medicine, Cork, Ireland. jennyporter@esatclear.ie
Markos
F
F
Snow
H M
HM
Shorten
G D
GD
D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000188:drug therapy*; D002122:Calcium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*; D004285:Dogs; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D009200:Myocardial Contraction / Q000187:drug effects; D020108:Nicorandil / Q000008:administration & dosage / Q000627:therapeutic use*; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D000077212:Ropivacaine; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016277:Ventricular Function, Left / Q000187:drug effects
D000577:Amides; D000779:Anesthetics, Local; D000889:Anti-Arrhythmia Agents; D014665:Vasodilator Agents; D020108:Nicorandil; D000077212:Ropivacaine; D005996:Nitroglycerin; D002122:Calcium Chloride