caa a22 4500 445374276 CHVBK 20180317142957.0 cr unu---uuuuu 170323e20111001xx s 000 0 eng 10.1007/s00540-011-1202-8 doi (NATIONALLICENCE)springer-10.1007/s00540-011-1202-8 Influence of bupivacaine injection dose rate on cardiovascular depression, subsequent hemodynamic course, and related bupivacaine plasma levels in piglets [Elektronische Daten] [Jacqueline Mauch, Annette Kutter, Olga Martin Jurado, Nelly Spielmann, Mital Dave, Regula Bettschart-Wolfensberger, Markus Weiss] Purpose: Systemic local anesthetic (LA) toxicity resulting from inadvertent intravascular injection of LA is a rare but potentially fatal event. Early recognition of intravascular injection and approaches to improve therapeutic safety are required. This study investigated the influence of intravascular injection dose rate of bupivacaine on bupivacaine plasma levels and timing of LA-induced cardiovascular compromise. Methods: Forty-five piglets, anesthetized with sevoflurane, were randomized into three groups. Bupivacaine was intravenously infused at a rate of 1, 4, or 16mg/kg/min (groups A, B, and C, respectively) until mean arterial pressure (MAP) dropped to 50% of initial value. Thereafter, bupivacaine infusion was stopped and spontaneous hemodynamic course was observed. Time to MAP50%, amount of bupivacaine infused, bupivacaine plasma level at infusion stop, spontaneous survivors, or time from bupivacaine stop to circulatory arrest were recorded. Results: Median time to MAP50% was 297, 119, and 65s, respectively, in groups A, B, and C (P<0.001). Median corresponding total amounts of bupivacaine infused were 5.0, 7.8, and 17.0mg/kg (P<0.01), and median bupivacaine plasma levels were 53.8, 180.0, and 439.8μmol/l (P<0.001). Five of 15 piglets in group A recovered spontaneously; in groups B and C, all animals died within 120 and 21s, respectively. Conclusion: Higher dose rates of bupivacaine showed much higher plasma bupivacaine levels related to absolute infused dose at MAP50% and were associated with an increased mortality. Slow administration of LA is recommended to allow timely detection and stopping of inadvertent intravascular administration. Japanese Society of Anesthesiologists, 2011 Local anesthetics nationallicence Cardiac toxicity nationallicence Regional anesthesia nationallicence Pediatric anesthesia nationallicence Mauch Jacqueline Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland aut Kutter Annette Section Anesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland aut Martin Jurado Olga Section Anesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland aut Spielmann Nelly Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland aut Dave Mital Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland aut Bettschart-Wolfensberger Regula Section Anesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland aut Weiss Markus Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland aut Journal of Anesthesia Springer Japan 25/5(2011-10-01), 710-715 0913-8668 25:5<710 2011 25 540 https://doi.org/10.1007/s00540-011-1202-8 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00540-011-1202-8 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Mauch Jacqueline Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland aut NATIONALLICENCE 700 1- Kutter Annette Section Anesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland aut NATIONALLICENCE 700 1- Martin Jurado Olga Section Anesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland aut NATIONALLICENCE 700 1- Spielmann Nelly Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland aut NATIONALLICENCE 700 1- Dave Mital Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland aut NATIONALLICENCE 700 1- Bettschart-Wolfensberger Regula Section Anesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland aut NATIONALLICENCE 700 1- Weiss Markus Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland aut NATIONALLICENCE 773 0- Journal of Anesthesia Springer Japan 25/5(2011-10-01), 710-715 0913-8668 25:5<710 2011 25 540 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer