Epinephrine Injection in Lipid-Based Resuscitation from Bupivacaine-Induced Cardiac Arrest: Transient Circulatory Return in Rabbits
Epinephrine Injection in Lipid-Based Resuscitation from Bupivacaine-Induced Cardiac Arrest: Transient Circulatory Return in Rabbits
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DOI：
10.1213/ane.0b013e3181e66050
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发表时间：
2010-09-01
影响因子：
5.7
通讯作者：
Lahner, Daniel
中科院分区：
文献类型：
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作者：
Harvey, Martyn;Cave, Grant;Lahner, Daniel
背景：静脉注射脂肪乳剂已被证明是治疗布比卡因引起的心脏毒性的有效方法。然而，肾上腺素与脂肪乳剂合用在毒素引起的心脏骤停中的作用尚不清楚。我们假设在布比卡因诱导的心脏骤停兔子模型中，在没有肾上腺素的情况下，通过静脉注射脂肪乳剂进行复苏，可以获得更好的复苏结果。方法：20只使用镇静剂的新西兰白兔接受10毫克/千克静脉注射布比卡因，产生心搏停止。 30 秒时开始机械通气和胸外按压。 1 分钟时，动物接受 5 mL/kg 20% 脂肪乳剂，另外 4 次静脉注射治疗中的 1 次（n = 5 个组）：0.9% 盐水、2.5 μg/kg 肾上腺素、10 μg/kg 肾上腺素、100 μg/kg 肾上腺素；全部为 1 mL/kg。 4 分钟时重复脂质乳液推注。 15 分钟内即可恢复自主循环和血流动力学指标。盐水组动物另外在15分钟时接受高剂量肾上腺素（100μg/kg）治疗，并监测20分钟。结果：与盐水对照组相比，高剂量肾上腺素给药与自主循环恢复率增加相关（盐水治疗组5只动物中的0只；2.5μg/kg肾上腺素组5只动物中的0只；10μg/kg组5只动物中的3只[P = 0.167]；100 μg/kg 组中 5 个中有 4 个 [P = 0.048]）。单独使用 100 μg/kg 组的 5 只动物中，有 4 只在 15 分钟内维持自发但递减的循环（P = 0.048）； 15 分钟时的平均动脉血压为 12.8 (SEM 2.8) mm Hg 生理盐水、12.0 (2.5) mm Hg 2.5 μg/kg 肾上腺素、20.6 (2.7) mm Hg 10 μg/kg 肾上腺素和 26.4 (3.9) mm Hg 100 μg/kg 肾上腺素 (P = 0.008）。盐水治疗组中的五只动物中，有四只在延迟肾上腺素治疗后表现出自主循环的恢复（P = 0.048）。高剂量肾上腺素给药与自主循环恢复前冠状动脉灌注压显着增加相关。结论：肾上腺素似乎是恢复自主循环所必需的，但随后与布比卡因诱导心脏骤停兔模型中血流动力学变量下降相关。需要进一步的研究来确定肾上腺素在局部麻醉引起的心脏骤停的脂质复苏中的作用。 （麻醉分析 2010；111：791-6）
BACKGROUND: IV lipid emulsion has demonstrated to be effective therapy for bupivacaine-induced cardiotoxicity. However, the role of epinephrine when coadministered with lipid emulsion in toxin-induced cardiac arrest is unclear. We postulated superior resuscitation outcome in the absence of epinephrine in a rabbit model of bupivacaine-induced cardiac arrest resuscitated with IV lipid emulsion.METHODS: Twenty sedated, instrumented New Zealand White rabbits received 10 mg/kg IV bupivacaine producing asystole. Mechanical ventilation and external chest compressions were commenced at 30 seconds. At 1 minute, animals received 5 mL/kg 20% lipid emulsion in addition to 1 of 4 additional IV treatments (n = 5 all groups): 0.9% saline, 2.5 mu g/kg epinephrine, 10 mu g/kg epinephrine, 100 mu g/kg epinephrine; all at 1 mL/kg. Lipid emulsion bolus was repeated at 4 minutes. Return of spontaneous circulation and hemodynamic metrics were obtained to 15 minutes. Saline group animals additionally received high-dose epinephrine (100 mu g/kg) treatment at 15 minutes, and were monitored to 20 minutes.RESULTS: High-dose epinephrine administration was associated with increased rate of return of spontaneous circulation compared with saline control (0 of 5 saline-treated animals; 0 of 5 animals in the 2.5 mu g/kg epinephrine group; 3 of 5 in the 10 mu g/kg group [P = 0.167]; and 4 of 5 in the 100 mu g/kg group [P = 0.048]). Spontaneous but decreasing circulation was maintained at 15 minutes in 4 of 5 animals in the 100 mu g/kg group alone (P = 0.048); mean arterial blood pressure at 15 minutes was 12.8 (SEM 2.8) mm Hg saline, 12.0 (2.5) mm Hg 2.5 mu g/kg epinephrine, 20.6 (2.7) mm Hg 10 mu g/kg epinephrine, and 26.4 (3.9) mm Hg 100 mu g/kg epinephrine (P = 0.008). Four of five animals in the saline-treated group exhibited return of spontaneous circulation after delayed epinephrine treatment (P = 0.048). High-dose epinephrine administration was associated with a significant increase in coronary perfusion pressure before return of spontaneous circulation.CONCLUSIONS: Epinephrine seemed to be necessary for return of spontaneous circulation, but was subsequently associated with declining hemodynamic variables in this rabbit model of bupivacaine-induced cardiac arrest. Further study is required to define the role of epinephrine in lipid-based resuscitation from local anesthetic-induced cardiac arrest. (Anesth Analg 2010;111:791-6)