title: Electrocardiographic alterations during intravascular application of three different test doses of bupivacaine and epinephrine: experimental study in neonatal pigs.
abstract: BACKGROUND
  Origin of electrocardiographic (ECG) alterations during intravascular injection of local anaesthetic solutions is controversial. The aim of this study was to elucidate whether epinephrine, bupivacaine or their combination is responsible for ECG alteration.
  
  
  METHODS
  Forty-five piglets were randomized into three groups. After induction of general anaesthesia using sevoflurane and peripheral venous cannulation, the trachea was intubated, the lungs were artificially ventilated, and anaesthesia was maintained by sevoflurane. Under steady state 0.2 ml kg(-1) and after 10 min 0.4 ml kg(-1) of one of the following three test solutions was administered i.v.: bupivacaine 0.125% (Group 1), bupivacaine 0.125%+epinephrine 1:200 000 (Group 2), and plain epinephrine 1:200,000 (Group 3). The ECG was analysed for alterations in heart rate and T-elevation.
  
  
  RESULTS
  After injection of 0.2 or 0.4 ml kg(-1) test solution, an increase in heart rate of at least 10% was found in none of Group 1 and in all of Groups 2 and 3. After application of 0.2 ml kg(-1) test solution, T-elevation was found in 7% of Group 1 and in 93% of Groups 2 and 3. The injection of 0.4 ml kg(-1) revealed a T-elevation in 27%, 100%, and 100%, respectively, in Groups 1, 2, and 3.
  
  
  CONCLUSIONS
  This animal model demonstrated that increases in heart rate and T-elevation in the ECG during i.v. application of a common test dose (0.2 ml kg(-1)) of bupivacaine are caused by epinephrine addition. Whether higher doses of bupivacaine alone can cause similar ECG changes or not requires further studies.
authors.affiliation: Department of Anaesthesia and Perioperative Medicine, Kantonsspital, Aarau, Switzerland. jacqueline.mauch@ksa.ch
authors.forename: J
authors.initials: J
authors.lastname: Mauch
authors.forename: A P N
authors.initials: AP
authors.lastname: Kutter
authors.forename: C
authors.initials: C
authors.lastname: Madjdpour
authors.forename: N
authors.initials: N
authors.lastname: Koepfer
authors.forename: A
authors.initials: A
authors.lastname: Frotzler
authors.forename: R
authors.initials: R
authors.lastname: Bettschart-Wolfensberger
authors.forename: M
authors.initials: M
authors.lastname: Weiss
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000494:pharmacology; D000818:Animals; D000831:Animals, Newborn; D002045:Bupivacaine / Q000008:administration & dosage* / Q000494:pharmacology; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D004562:Electrocardiography / Q000187:drug effects*; D004837:Epinephrine / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D008297:Male; D013268:Stimulation, Chemical; D034421:Sus scrofa
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D002045:Bupivacaine; D004837:Epinephrine