Effect of hypertonic saline on electrocardiography QRS duration in rabbit model of bupivacaine toxicity resuscitated by intravenous lipid

Abstract

SummaryIntravenous lipid emulsion is established therapy for bupivacaine induced cardiotoxicity. The benefit of combined hypertonic saline and lipid treatment is unexplored. In this experiment, sedated rabbits were resuscitated from bupivacaine‐induced asystole with intravenous lipid according to the Association of Anaesthetists of Great Britain and Ireland’s guideline, or by identical lipid dosing with hypertonic saline: 6 mEq.kg−1 21% sodium chloride. Early electrocardiography QRS prolongation was less with lipid plus hypertonic saline (mean (SD) QRS 0.19 (0.07) s lipid only vs 0.09 (0.01) s lipid plus hypertonic saline; p = 0.003) at 9 min though not different from the lipid only group at 20 min. No difference was observed in rates of circulatory return (7/10 lipid only and 9/10 lipid plus hypertonic saline; p = 0.58) or survival (5/10 lipid only and 6/10 lipid plus hypertonic saline; p = 1.00). Some benefit to cardiac conduction may be afforded by hypertonic saline co‐administered with lipid emulsion in bupivacaine‐induced cardiotoxicity.

The effects of levosimendan and dobutamine in experimental bupivacaine-induced cardiotoxicity

“…Experimental treatment protocols have included amrinone, isoprotrenol, insulin, clonidine, adrenalin, and phenylephrine. Currently only dobutamine and lipid infusion are generally recommended [14-24]. Despite all resuscitative efforts with dobutamine and lipid infusion treatment, accidental intravenous bupivacaine exposure can be fatal, and newer treatment options may prove helpful [3].…”

Systematic review of the effect of intravenous lipid emulsion therapy for local anesthetic toxicity

“…The three observational studies included in this review measured the LA dose required to cause death in 50% of the animals dosed (LD50),(115) compared the effect of ILE or saline on QRS widening using ILE or saline, (113) or compared ILE to hypertonic saline in combination with ILE. (114) Intravenous lipid emulsion was initiated immediately or within two minutes of the termination of LA administration (Table 3). Bupivacaine was used at 4 mg/kg (113), 10 mg/kg (114) or at several different doses.…”

“…(114) Intravenous lipid emulsion was initiated immediately or within two minutes of the termination of LA administration (Table 3). Bupivacaine was used at 4 mg/kg (113), 10 mg/kg (114) or at several different doses. (115) A benefit of ILE use was supported by the demonstration that lipid infusion increased the bupivacaine LD50 in rats by 48%, from 12.5 to 18.5 mg/kg, (115) and by reversing the lengthening of QRS interval induced by the injection of bupivacaine in pigs.…”