Korean J Anesthesiol.  2001 Feb;40(2):220-228. 10.4097/kjae.2001.40.2.220.

Electrocardiographic and Hemodynamic Changes during Recovery from Bupivacaine Toxicity in Anesthetized Dogs

• Cho HS
• Choi SJ
• Lee YM
• Gwak MS
• Yang MK
• Choi DH

• KMID: 2236827
• DOI: http://doi.org/10.4097/kjae.2001.40.2.220

Abstract

BACKGROUND: Severe cardiac arrhythmia after accidental intravascular injection of bupivacaine in the practice of regional anesthesia has been reported and is known to be difficult to treat. We evaluated the electrocardiographic and hemodynamic changes during recovery from bupivacaine-induced cardiac toxicity.
METHODS
In eight male dogs receiving pentobarbital, after baseline recordings were obtained, 0.5% bupivacaine was infused at a rate of 0.5 mg/kg/min intravenously until cardiac output decreased to 50% or less(1/2 CO), which was defined as the point of cardiac depression in this study. The hemodynamic and electrocardiographic parameters were recorded at 1/2 CO, and 5, 10, 15, 20, 30 and 40 min after 1/2 CO. The following electrocardiographic parameters were measured: duration of QRS complex and T wave, PR interval and the corrected QT interval, all determined on the lead II.
RESULTS
Mean arterial pressure was significantly decreased throughout the experimental period after 1/2 CO, and cardiac output and SO2 were significantly decreased until 20 min after 1/2 CO in comparison with those at baseline. All dogs had serious changes on the ECG. Heart rate and ECG changes returned to baseline within 20 min after 1/2 CO, but QRS duration remained increased until 30 min after 1/2 CO. Systemic vascular resistance, pulmonary vascular resistance and serum electrolytes were not changed with time.
CONCLUSIONS
In the absence of hypoxia, acidosis, and hyperkalemia, QRS duration returned to control values more slowly than other variables on the EKG after bupivacaine cardiac toxicity. MAP and PCWP recovered the slowest of all hemodynamic variables.

Keyword

Anesthetics, local: bupivacaine; Monitoring: electrocardiography; hemodynamics; Toxicity: bupivacaine

MeSH Terms

Acidosis
Anesthesia, Conduction
Animals
Anoxia
Arrhythmias, Cardiac
Arterial Pressure
Bupivacaine*
Cardiac Output
Depression
Dogs*
Electrocardiography*
Electrolytes
Heart Rate
Hemodynamics*
Humans
Hyperkalemia
Male
Pentobarbital
Vascular Resistance
Bupivacaine
Electrolytes
Pentobarbital