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Anesth Analg 2004;99:728-733
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000132691.84814.4E

ANESTHETIC PHARMACOLOGY

The Effect of Insulin on the Resuscitation of Bupivacaine-Induced Severe Cardiovascular Toxicity in Dogs

Jin-Tae Kim, MD, Chul-Woo Jung, MD, and Kook-Hyun Lee, MD

Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Korea

Address correspondence and reprint requests to Kook Hyun Lee, MD, Department of Anesthesiology, Seoul National University Hospital, #28, Yongon-Dong, Chongno-Gu, Seoul, Korea 110-744. Address e-mail to leekh{at}plaza.snu.ac.kr

Resuscitation after bupivacaine-induced cardiovascular collapse is difficult and often resistant to conventional treatment. We tested the hypothesis that insulin treatment would effectively reverse bupivacaine-induced cardiovascular collapse in pentobarbital-anesthetized dogs. Bupivacaine was administered at 0.5 mg · kg–1 · min–1 until mean arterial blood pressure decreased to 40 mm Hg or less. In the insulin-glucose-potassium (IGK) group (n = 7), an IV bolus of regular insulin (2 U/kg) was given, followed by a glucose infusion (2 mL/kg of 50% dextrose in water) for 30 min and a potassium infusion (1–2 mmol · kg–1 · h–1). In the control group (n = 7), glucose infusion was given as in the IGK group. In contrast to the control group, all IGK dogs survived. Mean arterial blood pressure, heart rate, cardiac output, mixed venous oxygen saturation, and end tidal CO2 recovered toward baseline levels in the IGK group. In conclusion, severe bupivacaine-induced cardiovascular collapse in dogs was effectively reversed with the insulin treatment.

IMPLICATIONS: Bupivacaine-induced cardiac toxicity is extremely difficult to treat. We found that profound cardiovascular depression by bupivacaine in dogs was effectively reversed with insulin-glucose-potassium infusion.






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 © 2004 by the International Anesthesia Research Society.