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Anesth Analg 1985; 64:911-916
© 1985 International Anesthesia Research Society
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Bupivacaine Cardiovascular Toxicity

Comparison of Treatment with Bretylium and Lidocaine

Gregory W. Kasten, MD, and Stuart T. Martin, MD, PhD

Department of Anesthesiology, University of Kentucky Albert B. Chandler Medical Center and Veterans Administration Medical Center, Lexington, Kentucky.

Abstract

Using anesthetized dogs, this study compared treatment with lidocaine or bretylium for bupivacaine-induced cardiovascular toxicity. Pentobarbital-anesthetized and -ventilated dogs (n = 10) were given a bolus dose of bupivacaine, 4 mg/kg, and a constant infusion of 0.2 mg·kg ·min–1 to produce steady-state serum levels of 7.1 ± 1.8 µg/ml of bupivacaine. Using burst ventricular pacing, the ventricular tachycardia threshold was determined, along with hemodynamic and electrophysiologic parameters. The animals were then treated with bretylium, 20 mg/kg (n = 5), or lidocaine, 2 mg/kg, followed by a continuous infusion of lidocaine, 0.1 mg·kg-1·min-1 (n = 5). Bupivacaine-induced alterations in cardiac output, stroke volume, heart rate, and systemic vascular resistance were corrected by bretylium but not lidocaine. Bupivacaine caused a significant lowering of the ventricular tachycardia threshold, which was consistently raised by bretylium, while lidocaine was either ineffective or caused a further lowering of the threshold. Bupivacaine caused a significant increase in the Q-TU interval and resulted in an undulating polymorphic ventricular tachycardia, similar to that seen in Torsades de Pointes.

Key Words: ANESTHETICS, LOCAL—bupivacaine • HEART, ARRHUTHMRAS—bretylium • TOXICITY—bupivacaine




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1985 by the International Anesthesia Research Society.