The hemodynamic effects of insulin following overdosage with levobupivacaine or racemic bupivacaine in dogs.
Although levobupivacaine (LBUP) is less cardiotoxic than racemic bupivacaine (RBUP), the resuscitation from the LBUP-induced cardiovascular collapse (CVC) has not been easy as expected. Following the recent reports that proposed the resuscitative action of insulin for the RBUP-induced CVC, a controlled trial was performed to assess the feasibility of insulin for the LBUP-induced CVC. Fourteen dogs were randomly allocated into two groups: the RBUP and LBUP groups. Each group received continuous intravenous infusions of RBUP or LBUP until the mean arterial pressure (MAP) reached 40 mmHg. Then, an intravenous bolus of insulin (2 U/kg) was administered. Both groups were successfully resuscitated. At CVC, a decrease of cardiac output and an increase of systemic vascular resistance were observed but to a lesser degree in the LBUP group (p<0.05). After insulin injection, the MAP further declined to under 40 mmHg for several minutes, which was more protracted in the LBUP group (p<0.05). The CVCs induced by LBUP or RBUP in anesthetized dogs could be successfully resuscitated by insulin. Compared with RBUP, however, the less degree of vasoconstriction by LBUP and the innate vasodilatory property of insulin yielded a delayed increment of MAP during the immediate resuscitation period in the LBUP-induced CVC.
Jung
Chul-Woo
CW
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 28 Yeongeon-dong, Jongno-gu, Seoul, Korea.
Kim
Jin-Tae
JT
Lee
Kook-Hyun
KH
D000779:Anesthetics, Local; D000818:Animals; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects*; D002045:Bupivacaine / Q000009:adverse effects* / Q000031:analogs & derivatives; D002302:Cardiac Output / Q000187:drug effects*; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D004285:Dogs; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D062787:Drug Overdose; D006323:Heart Arrest / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control*; D007328:Insulin / Q000008:administration & dosage*; D000077554:Levobupivacaine; D008297:Male; D016896:Treatment Outcome
D000779:Anesthetics, Local; D004338:Drug Combinations; D007328:Insulin; D000077554:Levobupivacaine; D002045:Bupivacaine