Influence of bupivacaine injection dose rate on cardiovascular depression, subsequent hemodynamic course, and related bupivacaine plasma levels in piglets
Purpose Systemic local anesthetic (LA) toxicity resulting from inadvertent intravascular injection of LA is a rare but potentially fatal event. Early recognition of intravascular injection and approaches to improve therapeutic safety are required. This study investigated the influence of intravascul...
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| Veröffentlicht in: | Journal of anesthesia 2011-10, Vol.25 (5), p.710-715 |
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| creator | Mauch, Jacqueline Kutter, Annette P. N. Martin Jurado, Olga Spielmann, Nelly Dave, Mital H. Bettschart-Wolfensberger, Regula Weiss, Markus |
| description | Purpose
Systemic local anesthetic (LA) toxicity resulting from inadvertent intravascular injection of LA is a rare but potentially fatal event. Early recognition of intravascular injection and approaches to improve therapeutic safety are required. This study investigated the influence of intravascular injection dose rate of bupivacaine on bupivacaine plasma levels and timing of LA-induced cardiovascular compromise.
Methods
Forty-five piglets, anesthetized with sevoflurane, were randomized into three groups. Bupivacaine was intravenously infused at a rate of 1, 4, or 16 mg/kg/min (groups A, B, and C, respectively) until mean arterial pressure (MAP) dropped to 50% of initial value. Thereafter, bupivacaine infusion was stopped and spontaneous hemodynamic course was observed. Time to MAP 50%, amount of bupivacaine infused, bupivacaine plasma level at infusion stop, spontaneous survivors, or time from bupivacaine stop to circulatory arrest were recorded.
Results
Median time to MAP 50% was 297, 119, and 65 s, respectively, in groups A, B, and C (
P
|
| doi_str_mv | 10.1007/s00540-011-1202-8 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_cross</sourceid><recordid>TN_cdi_gale_infotracmisc_A356266384</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A356266384</galeid><sourcerecordid>A356266384</sourcerecordid><originalsourceid>FETCH-LOGICAL-c571t-26e45a17d746fd542064e033af4ea061c9bcb261f0471a7d2873244a252c90563</originalsourceid><addsrcrecordid>eNp9kcuKFDEUhoMoTjv6AG4k4HYy5lap6uUweBkYcKPrcCo51aZJpcqkqmFexac1Q6kw0EgWgeT7_0PyEfJW8GvBefuhcN5ozrgQTEguWfeM7IRWHetUs39OdnwvFOuM6S7Iq1KOnHMjhHpJLqRodadauSO_7tIQV0wO6TTQfp3DCRyEhDSkI7olTIn6qSDNsFQkUQfZh-kExa0RMvU4ZyylYle0rH3Bn7VsoT9wnPxDgjE46qY1F7yikDzNGGuPfzJojlBGoBFPGEsdS-dwiLiU1-TFALHgmz_7Jfn-6eO32y_s_uvnu9ube-aaVixMGtQNiNa32gy-0ZIbjVwpGDRCfbDb966XRgxctwJaL7tWSa1BNtLteWPUJXm_9R4gog1pmJYMbgzF2RvVGGmM6nSl2BnqgAkzxCnhEOrxE_76DF-Xx_opZwNiC7g8lZJxsHMOI-QHK7h91G033bbqto-6bVcz77bMvPYj-n-Jv34rIDeg1Kt0wGyP1Uaq3_mf1t9KfraB</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Influence of bupivacaine injection dose rate on cardiovascular depression, subsequent hemodynamic course, and related bupivacaine plasma levels in piglets</title><source>MEDLINE</source><source>Springer Online Journals Complete</source><creator>Mauch, Jacqueline ; Kutter, Annette P. N. ; Martin Jurado, Olga ; Spielmann, Nelly ; Dave, Mital H. ; Bettschart-Wolfensberger, Regula ; Weiss, Markus</creator><creatorcontrib>Mauch, Jacqueline ; Kutter, Annette P. N. ; Martin Jurado, Olga ; Spielmann, Nelly ; Dave, Mital H. ; Bettschart-Wolfensberger, Regula ; Weiss, Markus</creatorcontrib><description>Purpose
Systemic local anesthetic (LA) toxicity resulting from inadvertent intravascular injection of LA is a rare but potentially fatal event. Early recognition of intravascular injection and approaches to improve therapeutic safety are required. This study investigated the influence of intravascular injection dose rate of bupivacaine on bupivacaine plasma levels and timing of LA-induced cardiovascular compromise.
Methods
Forty-five piglets, anesthetized with sevoflurane, were randomized into three groups. Bupivacaine was intravenously infused at a rate of 1, 4, or 16 mg/kg/min (groups A, B, and C, respectively) until mean arterial pressure (MAP) dropped to 50% of initial value. Thereafter, bupivacaine infusion was stopped and spontaneous hemodynamic course was observed. Time to MAP 50%, amount of bupivacaine infused, bupivacaine plasma level at infusion stop, spontaneous survivors, or time from bupivacaine stop to circulatory arrest were recorded.
Results
Median time to MAP 50% was 297, 119, and 65 s, respectively, in groups A, B, and C (
P
< 0.001). Median corresponding total amounts of bupivacaine infused were 5.0, 7.8, and 17.0 mg/kg (
P
< 0.01), and median bupivacaine plasma levels were 53.8, 180.0, and 439.8 μmol/l (
P
< 0.001). Five of 15 piglets in group A recovered spontaneously; in groups B and C, all animals died within 120 and 21 s, respectively.
Conclusion
Higher dose rates of bupivacaine showed much higher plasma bupivacaine levels related to absolute infused dose at MAP 50% and were associated with an increased mortality. Slow administration of LA is recommended to allow timely detection and stopping of inadvertent intravascular administration.</description><identifier>ISSN: 0913-8668</identifier><identifier>EISSN: 1438-8359</identifier><identifier>DOI: 10.1007/s00540-011-1202-8</identifier><identifier>PMID: 21748372</identifier><language>eng</language><publisher>Japan: Springer Japan</publisher><subject>Anesthesia ; Anesthesiology ; Anesthetics, Local - administration & dosage ; Anesthetics, Local - blood ; Anesthetics, Local - toxicity ; Animals ; Blood Pressure - drug effects ; Bupivacaine - administration & dosage ; Bupivacaine - blood ; Bupivacaine - toxicity ; Cardiovascular System - drug effects ; Central nervous system agents ; Critical Care Medicine ; Depression, Chemical ; Drug Administration Schedule ; Emergency Medicine ; Female ; Heart Arrest - blood ; Heart Arrest - chemically induced ; Hemodynamics - drug effects ; Infusions, Intravenous ; Intensive ; Male ; Medicine ; Medicine & Public Health ; Methyl Ethers - pharmacology ; Original Article ; Pain Medicine ; Random Allocation ; Swine</subject><ispartof>Journal of anesthesia, 2011-10, Vol.25 (5), p.710-715</ispartof><rights>Japanese Society of Anesthesiologists 2011</rights><rights>COPYRIGHT 2011 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c571t-26e45a17d746fd542064e033af4ea061c9bcb261f0471a7d2873244a252c90563</citedby><cites>FETCH-LOGICAL-c571t-26e45a17d746fd542064e033af4ea061c9bcb261f0471a7d2873244a252c90563</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00540-011-1202-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00540-011-1202-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21748372$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mauch, Jacqueline</creatorcontrib><creatorcontrib>Kutter, Annette P. N.</creatorcontrib><creatorcontrib>Martin Jurado, Olga</creatorcontrib><creatorcontrib>Spielmann, Nelly</creatorcontrib><creatorcontrib>Dave, Mital H.</creatorcontrib><creatorcontrib>Bettschart-Wolfensberger, Regula</creatorcontrib><creatorcontrib>Weiss, Markus</creatorcontrib><title>Influence of bupivacaine injection dose rate on cardiovascular depression, subsequent hemodynamic course, and related bupivacaine plasma levels in piglets</title><title>Journal of anesthesia</title><addtitle>J Anesth</addtitle><addtitle>J Anesth</addtitle><description>Purpose
Systemic local anesthetic (LA) toxicity resulting from inadvertent intravascular injection of LA is a rare but potentially fatal event. Early recognition of intravascular injection and approaches to improve therapeutic safety are required. This study investigated the influence of intravascular injection dose rate of bupivacaine on bupivacaine plasma levels and timing of LA-induced cardiovascular compromise.
Methods
Forty-five piglets, anesthetized with sevoflurane, were randomized into three groups. Bupivacaine was intravenously infused at a rate of 1, 4, or 16 mg/kg/min (groups A, B, and C, respectively) until mean arterial pressure (MAP) dropped to 50% of initial value. Thereafter, bupivacaine infusion was stopped and spontaneous hemodynamic course was observed. Time to MAP 50%, amount of bupivacaine infused, bupivacaine plasma level at infusion stop, spontaneous survivors, or time from bupivacaine stop to circulatory arrest were recorded.
Results
Median time to MAP 50% was 297, 119, and 65 s, respectively, in groups A, B, and C (
P
< 0.001). Median corresponding total amounts of bupivacaine infused were 5.0, 7.8, and 17.0 mg/kg (
P
< 0.01), and median bupivacaine plasma levels were 53.8, 180.0, and 439.8 μmol/l (
P
< 0.001). Five of 15 piglets in group A recovered spontaneously; in groups B and C, all animals died within 120 and 21 s, respectively.
Conclusion
Higher dose rates of bupivacaine showed much higher plasma bupivacaine levels related to absolute infused dose at MAP 50% and were associated with an increased mortality. Slow administration of LA is recommended to allow timely detection and stopping of inadvertent intravascular administration.</description><subject>Anesthesia</subject><subject>Anesthesiology</subject><subject>Anesthetics, Local - administration & dosage</subject><subject>Anesthetics, Local - blood</subject><subject>Anesthetics, Local - toxicity</subject><subject>Animals</subject><subject>Blood Pressure - drug effects</subject><subject>Bupivacaine - administration & dosage</subject><subject>Bupivacaine - blood</subject><subject>Bupivacaine - toxicity</subject><subject>Cardiovascular System - drug effects</subject><subject>Central nervous system agents</subject><subject>Critical Care Medicine</subject><subject>Depression, Chemical</subject><subject>Drug Administration Schedule</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Heart Arrest - blood</subject><subject>Heart Arrest - chemically induced</subject><subject>Hemodynamics - drug effects</subject><subject>Infusions, Intravenous</subject><subject>Intensive</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Methyl Ethers - pharmacology</subject><subject>Original Article</subject><subject>Pain Medicine</subject><subject>Random Allocation</subject><subject>Swine</subject><issn>0913-8668</issn><issn>1438-8359</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcuKFDEUhoMoTjv6AG4k4HYy5lap6uUweBkYcKPrcCo51aZJpcqkqmFexac1Q6kw0EgWgeT7_0PyEfJW8GvBefuhcN5ozrgQTEguWfeM7IRWHetUs39OdnwvFOuM6S7Iq1KOnHMjhHpJLqRodadauSO_7tIQV0wO6TTQfp3DCRyEhDSkI7olTIn6qSDNsFQkUQfZh-kExa0RMvU4ZyylYle0rH3Bn7VsoT9wnPxDgjE46qY1F7yikDzNGGuPfzJojlBGoBFPGEsdS-dwiLiU1-TFALHgmz_7Jfn-6eO32y_s_uvnu9ube-aaVixMGtQNiNa32gy-0ZIbjVwpGDRCfbDb966XRgxctwJaL7tWSa1BNtLteWPUJXm_9R4gog1pmJYMbgzF2RvVGGmM6nSl2BnqgAkzxCnhEOrxE_76DF-Xx_opZwNiC7g8lZJxsHMOI-QHK7h91G033bbqto-6bVcz77bMvPYj-n-Jv34rIDeg1Kt0wGyP1Uaq3_mf1t9KfraB</recordid><startdate>20111001</startdate><enddate>20111001</enddate><creator>Mauch, Jacqueline</creator><creator>Kutter, Annette P. N.</creator><creator>Martin Jurado, Olga</creator><creator>Spielmann, Nelly</creator><creator>Dave, Mital H.</creator><creator>Bettschart-Wolfensberger, Regula</creator><creator>Weiss, Markus</creator><general>Springer Japan</general><general>Springer</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20111001</creationdate><title>Influence of bupivacaine injection dose rate on cardiovascular depression, subsequent hemodynamic course, and related bupivacaine plasma levels in piglets</title><author>Mauch, Jacqueline ; Kutter, Annette P. N. ; Martin Jurado, Olga ; Spielmann, Nelly ; Dave, Mital H. ; Bettschart-Wolfensberger, Regula ; Weiss, Markus</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c571t-26e45a17d746fd542064e033af4ea061c9bcb261f0471a7d2873244a252c90563</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Anesthesia</topic><topic>Anesthesiology</topic><topic>Anesthetics, Local - administration & dosage</topic><topic>Anesthetics, Local - blood</topic><topic>Anesthetics, Local - toxicity</topic><topic>Animals</topic><topic>Blood Pressure - drug effects</topic><topic>Bupivacaine - administration & dosage</topic><topic>Bupivacaine - blood</topic><topic>Bupivacaine - toxicity</topic><topic>Cardiovascular System - drug effects</topic><topic>Central nervous system agents</topic><topic>Critical Care Medicine</topic><topic>Depression, Chemical</topic><topic>Drug Administration Schedule</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Heart Arrest - blood</topic><topic>Heart Arrest - chemically induced</topic><topic>Hemodynamics - drug effects</topic><topic>Infusions, Intravenous</topic><topic>Intensive</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Methyl Ethers - pharmacology</topic><topic>Original Article</topic><topic>Pain Medicine</topic><topic>Random Allocation</topic><topic>Swine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mauch, Jacqueline</creatorcontrib><creatorcontrib>Kutter, Annette P. N.</creatorcontrib><creatorcontrib>Martin Jurado, Olga</creatorcontrib><creatorcontrib>Spielmann, Nelly</creatorcontrib><creatorcontrib>Dave, Mital H.</creatorcontrib><creatorcontrib>Bettschart-Wolfensberger, Regula</creatorcontrib><creatorcontrib>Weiss, Markus</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Journal of anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mauch, Jacqueline</au><au>Kutter, Annette P. N.</au><au>Martin Jurado, Olga</au><au>Spielmann, Nelly</au><au>Dave, Mital H.</au><au>Bettschart-Wolfensberger, Regula</au><au>Weiss, Markus</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of bupivacaine injection dose rate on cardiovascular depression, subsequent hemodynamic course, and related bupivacaine plasma levels in piglets</atitle><jtitle>Journal of anesthesia</jtitle><stitle>J Anesth</stitle><addtitle>J Anesth</addtitle><date>2011-10-01</date><risdate>2011</risdate><volume>25</volume><issue>5</issue><spage>710</spage><epage>715</epage><pages>710-715</pages><issn>0913-8668</issn><eissn>1438-8359</eissn><abstract>Purpose
Systemic local anesthetic (LA) toxicity resulting from inadvertent intravascular injection of LA is a rare but potentially fatal event. Early recognition of intravascular injection and approaches to improve therapeutic safety are required. This study investigated the influence of intravascular injection dose rate of bupivacaine on bupivacaine plasma levels and timing of LA-induced cardiovascular compromise.
Methods
Forty-five piglets, anesthetized with sevoflurane, were randomized into three groups. Bupivacaine was intravenously infused at a rate of 1, 4, or 16 mg/kg/min (groups A, B, and C, respectively) until mean arterial pressure (MAP) dropped to 50% of initial value. Thereafter, bupivacaine infusion was stopped and spontaneous hemodynamic course was observed. Time to MAP 50%, amount of bupivacaine infused, bupivacaine plasma level at infusion stop, spontaneous survivors, or time from bupivacaine stop to circulatory arrest were recorded.
Results
Median time to MAP 50% was 297, 119, and 65 s, respectively, in groups A, B, and C (
P
< 0.001). Median corresponding total amounts of bupivacaine infused were 5.0, 7.8, and 17.0 mg/kg (
P
< 0.01), and median bupivacaine plasma levels were 53.8, 180.0, and 439.8 μmol/l (
P
< 0.001). Five of 15 piglets in group A recovered spontaneously; in groups B and C, all animals died within 120 and 21 s, respectively.
Conclusion
Higher dose rates of bupivacaine showed much higher plasma bupivacaine levels related to absolute infused dose at MAP 50% and were associated with an increased mortality. Slow administration of LA is recommended to allow timely detection and stopping of inadvertent intravascular administration.</abstract><cop>Japan</cop><pub>Springer Japan</pub><pmid>21748372</pmid><doi>10.1007/s00540-011-1202-8</doi><tpages>6</tpages></addata></record> |
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| ispartof | Journal of anesthesia, 2011-10, Vol.25 (5), p.710-715 |
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| source | MEDLINE; Springer Online Journals Complete |
| subjects | Anesthesia Anesthesiology Anesthetics, Local - administration & dosage Anesthetics, Local - blood Anesthetics, Local - toxicity Animals Blood Pressure - drug effects Bupivacaine - administration & dosage Bupivacaine - blood Bupivacaine - toxicity Cardiovascular System - drug effects Central nervous system agents Critical Care Medicine Depression, Chemical Drug Administration Schedule Emergency Medicine Female Heart Arrest - blood Heart Arrest - chemically induced Hemodynamics - drug effects Infusions, Intravenous Intensive Male Medicine Medicine & Public Health Methyl Ethers - pharmacology Original Article Pain Medicine Random Allocation Swine |
| title | Influence of bupivacaine injection dose rate on cardiovascular depression, subsequent hemodynamic course, and related bupivacaine plasma levels in piglets |
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