Electrocardiographic and Hemodynamic Effects of Intravenous Infusion of Bupivacaine, Ropivacaine, Levobupivacaine, and Lidocaine In Anesthetized Ewes

Guinet, P; Estèbe, Jean-Pierre; Ratajczak-Enselme, Maja; Bansard, Jean‐Yves; Chevanne, François; Bec, David; Lecorre, Pascal; Wodey, Éric; Ecoffey, Claude

doi:10.1097/aap.0b013e31819338e2

Cited by 22 publications

(11 citation statements)

References 29 publications

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“…The likelihood of successful resuscitation after local anaesthetic toxicity is lower with bupivacaine because of prolonged receptor binding. 67 However, lipid rescue may be more effective for bupivacaine than ropivacaine toxicity due to the lipophilic properties of bupivacaine. 68 There is little evidence to refute the use of bupivacaine for epidural anaesthesia or analgesia in adults.…”

Section: Choice Of Local Anaestheticmentioning

confidence: 99%

Failed epidural: causes and management

Hermanides

Hollmann

Stevens

et al. 2012

British Journal of Anaesthesia

337

223

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Failed epidural anaesthesia or analgesia is more frequent than generally recognized. We review the factors known to influence the success rate of epidural anaesthesia. Reasons for an inadequate epidural block include incorrect primary placement, secondary migration of a catheter after correct placement, and suboptimal dosing of local anaesthetic drugs. For catheter placement, the loss of resistance using saline has become the most widely used method. Patient positioning, the use of a midline or paramedian approach, and the method used for catheter fixation can all influence the success rate. When using equipotent doses, the difference in clinical effect between bupivacaine and the newer isoforms levobupivacaine and ropivacaine appears minimal. With continuous infusion, dose is the primary determinant of epidural anaesthesia quality, with volume and concentration playing a lesser role. Addition of adjuvants, especially opioids and epinephrine, may substantially increase the success rate of epidural analgesia. Adjuvant opioids may have a spinal or supraspinal action. The use of patient-controlled epidural analgesia with background infusion appears to be the best method for postoperative analgesia.

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Section: Choice Of Local Anaestheticmentioning

confidence: 99%

Failed epidural: causes and management

Hermanides

Hollmann

Stevens

et al. 2012

British Journal of Anaesthesia

337

223

View full text Add to dashboard Cite

show abstract

“…Our results demonstrate that icv ropivacaine produces dysrhythmias and increases artery blood pressure, which are associated with iv ropivacaine administration (Dony et al, 2000;Guinet et al, 2009).…”

Section: Discussionmentioning

confidence: 83%

Midazolam in rabbits terminates dysrhythmias caused by intracerebroventricular ropivacaine

Zhu

Yuan

et al. 2011

J. Zhejiang Univ. Sci. B

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Abstract:The current study was designed to investigate the mechanisms by which ropivacaine may act within the central nervous system (CNS) to produce cardiotoxicity. Eighty New Zealand rabbits were divided into four groups randomly. In Group 1, 20 rabbits received intracerebroventricular (icv) saline, and then received icv ropivacaine 30 min later. In Group 2, 20 rabbits received icv ropivacaine. Whenever dysrhythmias continued for more than 5 min, 0.1 ml saline was administered into the left cerebral ventricle. Ten minutes later, 0.1 ml midazolam was given into the left lateral ventricle. In Group 3, 20 rabbits received icv ropivacaine, and once the dysrhythmias developed, the inspired isoflurane concentration was increased from 0.75% to 1.50%. In Group 4, 20 animals received an intravenous (iv) phenylephrine infusion until dysrhythmias occurred. In Group 1, the rabbits did not develop dysrhythmias in response to icv saline, whereas dysrhythmias did develop in these animals after icv ropivacaine. In Group 2, icv saline had no effect on the dysrhythmias; however, icv midazolam terminated cardiac dysrhythmias. In Group 3, an increase in the concentration of the inspired isoflurane had no effect on dysrhythmias. In Group 4, icv midazolam had no effect on dysrhythmias in response to iv phenylephrine. Ropivacaine administered directly into the CNS is capable of producing cardiac dysrhythmias; midazolam terminated dysrhythmias presumably by potentiation of γ-aminobutyric acid (GABA) receptor activity. Our results suggest that ropivacaine produces some of its cardiotoxicity not only by the direct cardiotoxicity of the drug, but also by the CNS effects of ropivacaine.

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“…In our institution, bupivacaine is the long-acting local anesthetic of choice, however ropivacaine with its safer toxicity profile should be considered if available. 18 Niraj et al in their randomized clinical trial comparing epidural analgesia with TAP catheters for abdominal surgery, reported that 45% of catheters needed to be resited. 12 This may be due to differences in the procedure (subcostal approach) and also the different patient population.…”

Section: Discussionmentioning

confidence: 98%

Transversus abdominis plane catheters for post-cesarean delivery analgesia: a series of five cases

Richebé

Ortner

Landau

2012

International Journal of Obstetric Anesthesia

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Electrocardiographic and Hemodynamic Effects of Intravenous Infusion of Bupivacaine, Ropivacaine, Levobupivacaine, and Lidocaine In Anesthetized Ewes

Abstract: In our anesthetized ewe model, high dose IV infusion of BUPI induced the most marked changes in RR, PR, QRS, QT, QTc intervals, DeltaSAP, and DeltadP/dt. ROPI altered ECG variables less than BUPI but more than S-BUPI. LIDO was associated with the smallest changes.

Cited by 22 publications

References 29 publications

Failed epidural: causes and management

Failed epidural: causes and management

Midazolam in rabbits terminates dysrhythmias caused by intracerebroventricular ropivacaine

Transversus abdominis plane catheters for post-cesarean delivery analgesia: a series of five cases

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