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The hemodynamic effects of insulin following overdosage with levobupivacaine or racemic bupivacaine in dogs

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Authors
Jung, Chul-Woo; Kim, Jin-Tae; Lee, Kook-Hyun
Issue Date
2007-04-24
Publisher
Korean Academy of Medical Science
Citation
J Korean Med Sci. 2007 Apr;22(2):342-6.
Keywords
Anesthetics, LocalAnimalsBlood Flow Velocity/drug effectsBlood Pressure/*drug effectsBupivacaine/*adverse effects/analogs & derivativesCardiac Output/*drug effectsCardiopulmonary Resuscitation/methodsDogsDose-Response Relationship, DrugDrug CombinationsHeart Arrest/*chemically induced/physiopathology/*prevention & controlInsulin/*administration & dosageMaleOverdoseTreatment Outcome
Abstract
Although levobupivacaine (LBUP) is less cardiotoxic than racemic bupivacaine (RBUP), the resuscitation from the LBUP-induced cardiovascular collapse (CVC) has not been easy as expected. Following the recent reports that proposed the resuscitative action of insulin for the RBUP-induced CVC, a controlled trial was performed to assess the feasibility of insulin for the LBUP-induced CVC. Fourteen dogs were randomly allocated into two groups: the RBUP and LBUP groups. Each group received continuous intravenous infusions of RBUP or LBUP until the mean arterial pressure (MAP) reached 40 mmHg. Then, an intravenous bolus of insulin (2 U/kg) was administered. Both groups were successfully resuscitated. At CVC, a decrease of cardiac output and an increase of systemic vascular resistance were observed but to a lesser degree in the LBUP group (p<0.05). After insulin injection, the MAP further declined to under 40 mmHg for several minutes, which was more protracted in the LBUP group (p<0.05). The CVCs induced by LBUP or RBUP in anesthetized dogs could be successfully resuscitated by insulin. Compared with RBUP, however, the less degree of vasoconstriction by LBUP and the innate vasodilatory property of insulin yielded a delayed increment of MAP during the immediate resuscitation period in the LBUP-induced CVC.
ISSN
1011-8934 (Print)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17449947

http://hdl.handle.net/10371/29092
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College of Medicine/School of Medicine (의과대학/대학원)Anesthesiology and Pain Medicine (마취통증의학전공)Journal Papers (저널논문_마취통증의학전공)
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