Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-12-01T00:30:01.409Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects of bupivacaine used with sevoflurane on the rhythm and contractility in the isolated rat heart

Published online by Cambridge University Press:  02 June 2005

P. Bozkurt ,
Ö. Süzer ,
E. Ekici ,
Ö. Demirci ,
G. Kaya  and
M. Hacibekiroğlu
P. Bozkurt
Affiliation:
Istanbul University Cerrahpaşa Medical Faculty, Department of Anaesthesiology, Istanbul, Turkey
Ö. Süzer
Affiliation:
Istanbul University Cerrahpaşa Medical Faculty, Department of Pharmacology and Clinical Pharmacology, Istanbul, Turkey
E. Ekici
Affiliation:
Istanbul University Cerrahpaşa Medical Faculty, Department of Pharmacology and Clinical Pharmacology, Istanbul, Turkey
Ö. Demirci
Affiliation:
Istanbul University Cerrahpaşa Medical Faculty, Metropolitan Florence Nightingale Hospital, Istanbul, Turkey
G. Kaya
Affiliation:
Istanbul University Cerrahpaşa Medical Faculty, Department of Anaesthesiology, Istanbul, Turkey
M. Hacibekiroğlu
Affiliation:
Istanbul University Cerrahpaşa Medical Faculty, Fikret Biyal Laboratory, Istanbul, Turkey
Get access

Extract

Summary

Background and objective: The effects of sevoflurane on bupivacaine cardiotoxicity are mainly attributed to systemic effects. The purpose of this study was to investigate the direct myocardial effects of sevoflurane on bupivacaine toxicity.

Methods: Hearts of 30 Wistar albino rats were isolated and mounted on a Langendorff apparatus perfused by modified Tyrode solution. Experimental groups were: a sevoflurane group (Group S, n = 10) – following baseline and 20 min (Stage 1) recordings, sevoflurane was added in doses of 1.4% (1 MAC) and 2.8% (2 MAC). In the two bupivacaine groups, bupivacaine 5 μmol (Group B5, n = 10) and bupivacaine 10 μmol (Group B10, n = 10) was added to the solution at Stage 1, and sevoflurane was added to the system as in Group S. Haemodynamic variables, i.e. heart rate, PR interval, QRS duration, left ventricular systolic pressure, contractility (+dp/dtmax), relaxation, time to reach peak systolic pressure, change in left ventricular diastolic pressure from baseline, and rate–pressure product were recorded.

Results: In Group S, there was no change in cardiac rhythm. In bupivacaine groups, severe rhythm disturbances occurred and both the PR intervals and QRS complexes were prolonged significantly. All contractility variables deteriorated and the rate–pressure product decreased by 67–90% with the addition of bupivacaine. In all groups, 2 MAC sevoflurane lowered +dp/dtmax further.

Conclusions: Sevoflurane does not have any untoward effect on bupivacaine-induced cardiotoxicity in clinically relevant doses in the isolated rat heart.

Keywords

ANAESTHETICS, INHALATION, sevofluraneANAESTHETICS, LOCAL, bupivacaineCARDIOVASCULAR SYSTEM, HEART, heart conduction systemHEART DISEASES, arrhythmia
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 3 , March 2003 , pp. 199 - 204
Copyright
© 2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology 1979; 51: 285–287.Google Scholar
Singh P, Lee JS. Cardiovascular and central nervous system toxicity of local anesthetics. Seminars in Anesthesia, Perioperative Medicine and Pain 1998; 17: 18–23.Google Scholar
Heavner JE, Badgwell JM, Dreyden SF, Flinders C. Bupivacaine toxicity in lightly anesthetized pigs with respiratory imbalances plus or minus halothane. Reg Anesth 1995; 20: 20–26.Google Scholar
Umuroğlu T, Eti Z, Göğüş FY, Ay B, Yaycı A. The effects of sevoflurane and halothane anesthesia on bupivacaine cardiotoxicity in rabbits. J Turk Soc Algology 1998; 10: 29–34.Google Scholar
Badgwell JM, Heavner JE, Kytta J. Bupivacaine toxicity in young pigs is age dependent and is affected by volatile anesthetics. Anesthesiology 1990; 73: 297–303.Google Scholar
Fukuda H, Hirabayashi YY, Shimizu R, Saitoh K, Mitsuhata H. Sevoflurane is equivalent to isoflurane for attenuating bupivacaine induced arrhythmias and seizures in rats. Anesth Analg 1996; 83: 570–573.Google Scholar
Ohmuro S, Ohta T, Yamamoto K, Kobayashi T. A comparison of the effects of propofol and sevoflurane on the systemic toxicity of intravenous bupivacaine in rats. Anesth Analg 1999; 88: 155–159.Google Scholar
Clarkson CW, Hondeghem LM. Mechanism for bupivacaine depression of cardiac conduction. Fast block of sodium channels during the action potential with slow recovery from block during diastole. Anesthesiology 1985; 62: 396–405.Google Scholar
Hanouz JL, Vivien B, Guegniaud PY, Lecarpentier Y, Coriat P, Riou B. Comparison of the effects of isoflurane and halothane on rat myocardium. Br J Anaesth 1998; 80: 621–627.Google Scholar
Bozkurt AK, Süzer Ö, Kaynar M. Benefits of supplementing St. Thomas' Hospital cardioplegic solution with tetraethylammonium on functional and metabolic recovery of isolated rat hearts. Cardiovasc Surg 1997; 5: 117–124.Google Scholar
Walker MJ, Curtis MJ, Hearse DJ, et al. The Lambeth Conventions: guidelines for the study of arrhythmias in ischaemia infarction, and reperfusion. Cardiovasc Res 1988; 22: 447–455.Google Scholar
Thomas RD, Behbehani MM, Coyle DE, Denson DD. Cardiovascular toxicity of local anesthetics an alternative hypothesis. Anesth Analg 1986; 65: 444–450.Google Scholar
Nishikawa K, Terai T, Morimotu O, Yukioka H, Asada A. Bupivacaine does not suppress cardiac sympathetic nerve activity during halothane anesthesia in the cat. Acta Anaesthesiol Scand 1997; 40: 595–601.Google Scholar
Graf BM, Martin E, Nosnkaj ZJ, Stowe DF. Stereospecific effect of bupivacaine isomers on atrioventricular conduction in the isolated perfused guinea pig heart. Anesthesiology 1997; 86: 410–419.Google Scholar
Eledjam JJ, de la Coussaya JE, Bassoul B, Brugeda J. Mechanisms of cardiac toxicity of bupivacaine. Ann Fr Reanim 1988; 3: 204–210.Google Scholar
Freysz M, Timour Q, Bertrix L, Loufoua-Moundanga J, Omar S, Faucon G. Enhancement by ischemia of the risk of cardiac disorders, especially fibrillation, in regional anesthesia with bupivacaine. Acta Anaesthesiol Scand 1993; 37: 350–356.Google Scholar
Timour Q, Gaillard P, Bui-Xuan B, Vial T, Evreux JC, Freysz M. Cardiac accidents of locoregional anesthesia: experimental study of risk factors with bupivacaine. Bull Acad Natl Med 1998; 182: 217–232.Google Scholar
Park WP, Pancrazio J, Suh CK, Lynch C. Myocardial depressant effects of sevoflurane. Anesthesiology 1996; 84: 1166–1176.Google Scholar
Harkin CP, Pagel PS, Kersten JR, Hetitrick D, Waltier D. Direct negative inotropic and lusitropic effects of sevoflurane. Anesthesiology 1994; 81: 156–157.Google Scholar
Bosnjak ZJ, Stowe DF, Kampine JP. Comparison of lidocaine and bupivacaine depression of sinoatrial nodal activity during hypoxia and acidosis in adult and neonatal guinea pigs. Anesth Analg 1986; 65: 911–917.Google Scholar
Knudsen K, Beckman S, Blomberg S, Sjovall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 1997; 78: 507–514.Google Scholar