Korean J Anesthesiol.  1988 Feb;21(1):102-116. 10.4097/kjae.1988.21.1.102.

Effects of Bupivacaine on Calcium Transport Across Biological Membranes and Its Cardiotoxicity

• Jeoung BY
• Kim KJ

• KMID: 2239492
• DOI: http://doi.org/10.4097/kjae.1988.21.1.102

Abstract

A new local anesthetic, bupivacaine, is widely used for regional anesthesia because of its high potency and long duration of action. However, bupivacaine is reported to result in cardiovascular collapse associated with convulsion at a plasma concentration above the normal one, while other local anesthetics do not. Also resuscitation is very difficult. Although the mechanism of this action is not known, bupivacaine seems to have an influence on Ca2+ transport across cell membranes via various pathways. The present study was designed to evaluate the effects of bupivacaine on Ca2+ transport across cell membranes. The results are as follows: 1) Bupivacaine inhibites Ca2+ uptake by SR of skeletal muscle. 2) Bupivacaine suppressed the Bowditch and Woodworth staircase phenomena in a guines pig's left auricle, however this was reversible even at convulsant doses. 3) Bupivacaine also suppressed the Na+-Ca2+ exchange pump on guines pig's left auricle. 4) Bupivacaine increased the Ca2+-ATPase activity by SR of skeletal muscle. 5) At concentrations above 3ug/ml, bupivacaine induced cardiac arrhythmia. These findings suggest that bupivacaine-induced cardiotoxicity is possibly due to a Ca2+- channel blockade, depression of the Na+-Ca2+ pump, inhibition of Ca2+ uptake by SR and subsequent decrease of intracellular Ca2+ concentration.

Keyword

Anesthetics-local; bupivacaine; Ca2+ transport; Cardiotoxicity

MeSH Terms

Anesthesia, Conduction
Anesthetics, Local
Arrhythmias, Cardiac
Bupivacaine*
Calcium*
Cell Membrane
Depression
Membranes*
Muscle, Skeletal
Plasma
Resuscitation
Seizures
Anesthetics, Local
Bupivacaine
Calcium