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CARDIOVASCULAR ANESTHESIA

Bupivacaine Suppresses [Ca²⁺]_i Oscillations in Neonatal Rat Cardiomyocytes with Increased Extracellular K+ and Is Reversed with Increased Extracellular Mg²⁺

Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Address correspondence and reprint requests to Patrick P. McCaslin, MD, Department of Anesthesiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1009. Address e-mail to mccaslin{at}wfubmc.edu

Lidocaine is used to treat cardiac arrhythmias, whereas bupivacaine is noted for its cardiotoxicity. A precise mechanism for these differences is unclear, and there is no well defined antidote for local anesthetic cardiotoxicity. Our study compares the effect of lidocaine and bupivacaine on oscillations of intracellular Ca²⁺ coupled with contractions in neonatal rat cardiomyocytes by using digital imaging. In medium containing 5.6 mM K⁺, both 42 µM lidocaine and 5.5 µM bupivacaine significantly reduced the oscillation rate. The oscillatory patterns were highly irregular, and the rates were increased in the presence of bupivacaine in 7.6 mM K⁺ medium, eventually degenerating into a loss of oscillations after several minutes of bupivacaine exposure. Irregular oscillations did not occur with lidocaine until the K⁺ concentration was increased to 10 mM. Increasing the Mg²⁺ and Ca²⁺ concentrations by 2 mM each recovered oscillation that had been suppressed by bupivacaine in high K⁺ buffer. Evaluation of intracellular Ca²⁺ oscillations in neonatal rat suggests that increased extracellular K⁺ may be an important component of bupivacaine cardiotoxicity.

Implications: Evaluation of intracellular Ca²⁺ oscillations in neonatal rat myocytes suggests that increased extracellular K⁺ may be an important component of bupivacaine cardiotoxicity.

This article has been cited by other articles:

				L. Groban, D. D. Deal, J. C. Vernon, R. L. James, and J. Butterworth Cardiac Resuscitation After Incremental Overdosage with Lidocaine, Bupivacaine, Levobupivacaine, and Ropivacaine in Anesthetized Dogs Anesth. Analg., January 1, 2001; 92(1): 37 - 43. [Abstract] [Full Text] [PDF]

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