title: Resuscitation strategies from bupivacaine-induced cardiac arrest.
abstract: OBJECTIVE
  Local anesthetic (LA) intoxication with cardiovascular arrest is a potential fatal complication of regional anesthesia. Lipid resuscitation has been recommended for the treatment of LA-induced cardiac arrest. Aim of the study was to compare four different rescue regimens using epinephrine and/or lipid emulsion and vasopressin to treat cardiac arrest caused by bupivacaine intoxication.
  
  
  METHODS
  Twenty-eight piglets were randomized into four groups (4 × 7), anesthetized with sevoflurane, intubated, and ventilated. Bupivacaine was infused with a syringe driver via central venous catheter at a rate of 1 mg·kg(-1)·min(-1) until circulatory arrest. Bupivacaine infusion and sevoflurane were then stopped, chest compression was started, and the pigs were ventilated with 100% oxygen. After 1 min, epinephrine 10 μg·kg(-1) (group 1), Intralipid(®) 20% 4 ml·kg(-1) (group 2), epinephrine 10 μg·kg(-1) + Intralipid(®) 4 ml·kg(-1) (group 3) or 2 IU vasopressin + Intralipid(®) 4 ml·kg(-1) (group 4) were administered. Secondary epinephrine doses were given after 5 min if required.
  
  
  RESULTS
  Survival was 71%, 29%, 86%, and 57% in groups 1, 2, 3, and 4. Return of spontaneous circulation was regained only by initial administration of epinephrine alone or in combination with Intralipid(®). Piglets receiving the combination therapy survived without further epinephrine support. In contrast, in groups 2 and 4, return of spontaneous circulation was only achieved after secondary epinephrine rescue.
  
  
  CONCLUSIONS
  In cardiac arrest caused by bupivacaine intoxication, first-line rescue with epinephrine and epinephrine + Intralipid(®) was more effective with regard to survival than Intralipid(®) alone and vasopressin + Intralipid(®) in this pig model.
authors: Department of Anesthesiology, University Children's Hospital Zurich, Zurich, Switzerland. jacqueline.mauch@kispi.uzh.ch
authors: Jacqueline
authors: J
authors: Mauch
authors: Olga Martin
authors: OM
authors: Jurado
authors: Nelly
authors: N
authors: Spielmann
authors: Regula
authors: R
authors: Bettschart-Wolfensberger
authors: Markus
authors: M
authors: Weiss
mesh_terms: D000779:Anesthetics, Local / Q000009:adverse effects* / Q000097:blood; D000818:Animals; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000009:adverse effects* / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002851:Chromatography, High Pressure Liquid; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography / Q000187:drug effects; D004655:Emulsions / Q000627:therapeutic use; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced* / Q000628:therapy*; D008297:Male; D013058:Mass Spectrometry; D010743:Phospholipids / Q000627:therapeutic use; D013024:Soybean Oil / Q000627:therapeutic use; D016019:Survival Analysis; D013552:Swine; D017180:Tachycardia, Ventricular / Q000139:chemically induced / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use; D014693:Ventricular Fibrillation / Q000139:chemically induced / Q000628:therapy
chemical_list: D000779:Anesthetics, Local; D004655:Emulsions; D010743:Phospholipids; D014662:Vasoconstrictor Agents; C545823:soybean oil, phospholipid emulsion; D014667:Vasopressins; D013024:Soybean Oil; D002045:Bupivacaine; D004837:Epinephrine