title: Insulin/glucose infusion successfully resuscitates bupivacaine-induced sudden-onset circulatory collapse in dogs.
abstract: OBJECTIVE
  In previous studies, insulin reversed the cardiac toxicity gradually induced by a continuous infusion of bupivacaine. In this randomized controlled study, we intended to simulate a more relevant clinical situation by injecting bupivacaine rapidly as a bolus to induce sudden-onset circulatory collapse in dogs. We then evaluated the insulin effect.
  
  
  METHODS
  Bupivacaine (10 mg.kg(-1) iv) was rapidly administered intravenously to 12 dogs. At the onset of circulatory collapse (defined as a mean arterial pressure [MAP] of 30 mmHg), external chest compression was initiated. Insulin (2 U.kg(-1) iv) was given to the insulin-glucose (IG) group (n = 6) and the same volume of 0.9% saline was given to the control (C) group (n = 6). The primary outcome was successful resuscitation defined as both MAP ≥ 60 mmHg and sinus rhythm on an electrocardiogram that lasted ≥ 60 sec. Hemodynamic and blood variables were measured, including cardiac output and electrocardiogram intervals.
  
  
  RESULTS
  All IG dogs were successfully resuscitated within 15 (3) min, whereas none of the control dogs were resuscitated (P = 0.002). After circulatory collapse, the average MAP was higher in group IG than in group C (P = 0.006).
  
  
  CONCLUSIONS
  Insulin effectively reversed the sudden-onset circulatory collapse in dogs caused by an intravenous bolus injection of bupivacaine.
authors: Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors: Mi-Hyun
authors: MH
authors: Kim
authors: Kook-Hyun
authors: KH
authors: Lee
authors: Chong-Soo
authors: CS
authors: Kim
authors: Solmon
authors: S
authors: Yang
authors: Teserendorj
authors: T
authors: Uugangerel
authors: Chong-Min
authors: CM
authors: Kim
authors: Byeong-Chul
authors: BC
authors: Kang
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage / Q000633:toxicity; D000818:Animals; D062186:Arterial Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000633:toxicity*; D002302:Cardiac Output; D004195:Disease Models, Animal; D004285:Dogs; D004562:Electrocardiography; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use*; D007275:Injections, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods; D012769:Shock / Q000139:chemically induced / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D007328:Insulin; D005947:Glucose; D002045:Bupivacaine