J Korean Med Sci.  2007 Apr;22(2):342-346. 10.3346/jkms.2007.22.2.342.

The Hemodynamic Effects of Insulin Following Overdosage with Levobupivacaine or Racemic Bupivacaine in Dogs

• Jung CW
• Kim JT
• Lee KH

• KMID: 1713198
• DOI: http://doi.org/10.3346/jkms.2007.22.2.342

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.

Keyword

Bupivacaine; Cardiopulmonary Resuscitation; Insulin

MeSH Terms

Treatment Outcome
Overdose
Male
Insulin/*administration & dosage
Heart Arrest/*chemically induced/physiopathology/*prevention & control
Drug Combinations
Dose-Response Relationship, Drug
Dogs
Cardiopulmonary Resuscitation/methods
Cardiac Output/*drug effects
Bupivacaine/*adverse effects/analogs & derivatives
Blood Pressure/*drug effects
Blood Flow Velocity/drug effects
Animals
Anesthetics, Local

Figure

• 

  Fig. 1 Sequential changes of SVR, MAP, and CO. The decrease of CO and the increase in SVR were observed but to a lesser degree in the LBUP group. MAP further declined to under 40 mmHg for several minutes after insulin injection in both groups, and the restoration of MAP was more delayed in the LBUP group (p<0.05). Values are expressed as mean (dots) with SD (error bars). 'C+' means minutes after CVC. CVC, cardiovascular collapse (MAP=40 mmHg); RBUP, racemic bupivacaine; LBUP, levobupivacaine; SVR, systemic vascular resistance; MAP, mean arterial pressure; CO, cardiac output. *p<0.05 vs. baseline value; †p<0.05 vs. CVC value; ‡p<0.05 higher than in the other group.

• 

  Fig. 2 Sequential changes of ECG parameters such as QTc, PR, and QRS intervals. No distinguishable changes are discovered by ECG analysis, except PR and QRS interval prolongations at CVC. The restoration of parametric value is only seen in QRS interval. Values are expressed as mean (dots) with SD (error bars). 'C+' means minutes after CVC. CVC, cardiovascular collapse (MAP=40 mmHg); RBUP, racemic bupivacaine; LBUP, levobupivacaine; QTc, corrected QT. *p<0.05 vs. baseline value; †p<0.05 vs. CVC value; ‡p<0.05 higher than in the other group.

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