Murat KARCIOĞLU, Kasım TUZCU, Fatih SEFİL, Işıl DAVARCI, Suzan AYDIN, Ali SARI, Akın AYDOĞAN, Raif ÖZDEN

Efficacy of resuscitation with Intralipid in a levobupivacaine-induced cardiac arrest model

Cardiac toxicity due to the administration of local anesthetics may be fatal. In this study, we evaluated the efficacy of a 20% lipid solution combined with epinephrine in a levobupivacaine-induced cardiac arrest model. Materials and methods: A total of 14 New Zealand rabbits were sedated and mechanically ventilated. Asystole was induced with intravenous levobupivacaine injection. The rabbits were randomized into groups receiving the same volume of either 0.9% saline (CR group) or a 20% lipid solution (LE group) along with a 100 µg/kg epinephrine bolus, which were administered immediately upon asystole. Standard advanced cardiac life support protocols were performed. Results: Four subjects in the LE group as well as 3 subjects in the CR group had a spontaneous recovery (P = 0.592). In the 20th minute after arrest, 3 subjects in the LE group had maintained spontaneous circulation, while there was only 1 subject from the CR group with the same outcome. Conclusion: We found that adding a lipid solution to epinephrine for the resuscitation of rabbits that underwent levobupivacaine-induced cardiac arrest increased recovery rates of circulation and therefore the likelihood of survival. Further studies are needed to develop clinical therapies for the systemic toxicity of local anesthetics.

Anahtar Kelimeler:

Key words: Levobupivacaine, lipid emulsion, epinephrine, toxicity, resuscitation

Efficacy of resuscitation with Intralipid in a levobupivacaine-induced cardiac arrest model

Keywords:

Key words: Levobupivacaine, lipid emulsion, epinephrine, toxicity, resuscitation,

PDF

___

Cave G, Harvey MG, Winterbottom T. Evaluation of the Association of Anaesthetists of Great Britain and Ireland lipid infusion protocol in bupivacaine induced cardiac arrest in rabbits. Anaesthesia 2009; 64: 732–737.
Litz RJ, Popp M, Stehr SN, Koch T. Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion. Anaesthesia 2006; 61: 800–801.
Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB. Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology 2006; 105: 217–218.
Foxall G, McCahon R, Lamb J, Hardman JG, Bedforth NM. Levobupivacaine-induced seizures and cardiovascular collapse treated with Intralipid. Anaesthesia 2007; 62: 516–518.
McCutchen T, Gerancher JC. Early Intralipid therapy may have prevented bupivacaine-associated cardiac arrest. Reg Anesth Pain Med 2008; 33: 178–180.
Warren JA, Thoma RB, Georgescu A, Shah SJ. Intravenous lipid infusion in the successful resuscitation of local anestheticinduced cardiovascular collapse after supraclavicular brachial plexus block. Anesth Analg 2008; 106: 1578–1580.
Ludot H, Tharin JY, Belouadah M, Mazoit JX, Malinovsky JM. Successful resuscitation after ropivacaine and lidocaineinduced ventricular arrhythmia following posterior lumbar plexus block in a child. Anesth Analg 2008; 106: 1572–1574.
Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology 1998; 88: 1071–1075.
Weinberg G, Ripper R, Feinstein DL, Hoffman W. Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity. Reg Anesth Pain Med 2003; 28: 198–202.
Stehr SN, Ziegeler JC, Pexa A, Oertel R, Deussen A, Koch T, Hubler M. The effects of lipid infusion on myocardial function and bioenergetics in l-bupivacaine toxicity in the isolated rat heart. Anesth Analg 2007; 104: 186–192.
Litz RJ, Roessel T, Heller AR, Stehr SN. Reversal of central nervous system and cardiac toxicity after local anesthetic intoxication by lipid emulsion injection. Anesth Analg 2008; 106: 1575–1577.
Neal JM, Bernards CM, Butterworth JFT, Di Gregorio G, Drasner K, Hejtmanek MR, Mulroy MF, Rosenquist RW, Weinberg GL. ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med 2010; 35: 152–161.
Penson PE, Ford WR, Broadley KJ. Vasopressors for cardiopulmonary resuscitation. Does pharmacological evidence support clinical practice? Pharmacol Ther 2007; 115: 37–
Manavi MV. Lipid infusion as a treatment for local anesthetic toxicity: a literature review. AANA J 2010; 78: 69–78.
Hiller DB, Gregorio GD, Ripper R, Kelly K, Massad M, Edelman L, Edelman G, Feinstein DL, Weinberg GL. Epinephrine impairs lipid resuscitation from bupivacaine overdose: a threshold effect. Anesthesiology 2009; 111: 498–505.
Weinberg GL, Di Gregorio G, Ripper R, Kelly K, Massad M, Edelman L, Schwartz D, Shah N, Zheng S, Feinstein DL. Resuscitation with lipid versus epinephrine in a rat model of bupivacaine overdose. Anesthesiology 2008; 108: 907–913.
Heavner JE, Pitkanen MT, Shi B, Rosenberg PH. Resuscitation from bupivacaine-induced asystole in rats: comparison of different cardioactive drugs. Anesth Analg 1995; 80: 1134– 11
Ohmura S, Kawada M, Ohta T, Yamamoto K, Kobayashi T. Systemic toxicity and resuscitation in bupivacaine-, levobupivacaine-, or ropivacaine-infused rats. Anesth Analg 2001; 93: 743–748.
Groban L, Deal DD, Vernon JC, James RL, Butterworth J. Cardiac resuscitation after incremental overdosage with lidocaine, bupivacaine, levobupivacaine, and ropivacaine in anesthetized dogs. Anesth Analg 2001; 92: 37–43.
Mayr VD, Raedler C, Wenzel V, Lindner KH, Strohmenger HU. A comparison of epinephrine and vasopressin in a porcine model of cardiac arrest after rapid intravenous injection of bupivacaine. Anesth Analg 2004; 98: 1426–1431.
Harvey M, Cave G, Prince G, Lahner D. Epinephrine injection in lipid-based resuscitation from bupivacaine-induced cardiac arrest: transient circulatory return in rabbits. Anesth Analg 2010; 111: 791–796.
Otlewski MP, Geddes LA, Pargett M, Babbs CF. Methods for calculating coronary perfusion pressure during CPR. Cardiovasc Eng 2009; 9: 98–103.
Mazoit JX, Le Guen R, Beloeil H, Benhamou D. Binding of longlasting local anesthetics to lipid emulsions. Anesthesiology 2009; 110: 380–386.
Harvey M, Cave G, Kazemi A. Intralipid infusion diminishes return of spontaneous circulation after hypoxic cardiac arrest in rabbits. Anesth Analg 2009; 108: 1163–1168.
Kjaeve JC, Dahl PE. Pulmonary hypertension and microvascular injury in rats given parenteral nutrition. Acta Chir Scand 1989; 155: 439–443.
Barrington KJ, Chan G, Van Aerde JE. Intravenous lipid composition affects hypoxic pulmonary vasoconstriction in the newborn piglet. Can J Physiol Pharmacol 2001; 79: 594– 600.
Lloyd TR, Boucek MM. Effect of Intralipid on the neonatal pulmonary bed: an echographic study. J Pediatr 1986; 108: 130–133.
Dahms BB, Halpin TC Jr. Pulmonary arterial lipid deposit in newborn infants receiving intravenous lipid infusion. J Pediatr 1980; 97: 800–805.
Takifuji K, Tanimura H. Adverse effects of intravenous fat emulsion administration. Nihon Geka Gakkai Zasshi 1998; 99: 171–175.
Totaro RJ, Raper RF. Epinephrine-induced lactic acidosis following cardiopulmonary bypass. Crit Care Med 1997; 25: 1693–1699.
Reinikainen M, Hedman A, Pelkonen O, Ruokonen E. Cardiac arrest after interscalene brachial plexus block with ropivacaine and lidocaine. Acta Anaesthesiol Scand 2003; 47: 904–906.