Comparação das alterações hemodinâmicas na intoxicação aguda com bupivacaína e ropivacaína por via venosa em suínos

Marcos De Simone Melo; William Adalberto Silva; Ana Cristina de Moraes; Artur Udelsmann

doi:10.1590/S0034-70942009000500008

Scientific Article

Comparação das alterações hemodinâmicas na intoxicação aguda com bupivacaína e ropivacaína por via venosa em suínos

Comparison of hemodynamic changes in acute intoxication with intravenous bupivacaine and ropivacaine in swine

Marcos De Simone Melo; William Adalberto Silva; Ana Cristina de Moraes; Artur Udelsmann

http://dx.doi.org/10.1590/S0034-70942009000500008 Braz J Anesthesiol, vol.59, n5, p.592-601, 2009

PDF

Downloads: 0

Resumo

JUSTIFICATIVA E OBJETIVOS: A ropivacaína apresentada na forma levógira pura foi introduzida para proporcionar alternativa mais segura que a bupivacaína nas anestesias locorregionais. O objetivo deste estudo foi comparar as repercussões hemodinâmicas após injeção por via venosa dos dois agentes em suínos, simulando intoxicação que pode ocorrer durante anestesia locorregional em humanos. MÉTODO: Suínos da raça Large-White foram anestesiados com tiopental, realizada intubação traqueal e instituída ventilação controlada mecânica. As variáveis hemodinâmicas foram medidas através de monitorização invasiva da pressão arterial e cateterização de artéria pulmonar. Após período de repouso de 30 minutos os animais foram aleatoriamente divididos em dois grupos e receberam por via venosa 4 mg.kg-1 de um ou outro agente sem conhecimento do pesquisador. Os resultados hemodinâmicos foram avaliados em repouso e 1, 5, 10, 15, 20 e 30 minutos após a intoxicação. RESULTADOS: As repercussões hemodinâmicas da intoxicação aguda com bupivacaína foram mais importantes e mais prolongadas do que as com ropivacaína. Com bupivacaína o índice cardíaco teve diminuição maior e mais prolongado, a pressão arterial média e a frequência cardíaca diminuições mais prolongadas, a pressão venosa central aumento mais prolongado e a pressão capilar pulmonar aumentou mais e por mais tempo. O impacto no índice de resistência vascular sistêmica mostrou que a vasomotricidade foi parcialmente mantida, houve aumento nos dois grupos e, paradoxalmente, maior e por mais tempo com bupivacaína. CONCLUSÕES: Em suínos a ropivacaína causou menos repercussões hemodinâmicas do que a bupivacaína quando as mesmas doses foram injetadas por via venosa.

Palavras-chave

ANESTESIA, Local, ANESTESIA, Local, COMPLICAÇÕES, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Pure levorotatory ropivacaine was introduced to provide a safer alternative to bupivacaine in regional blocks. The objective of this study was to compare the hemodynamic repercussions after the intravenous administration of both agents in swine, simulating the intoxication that can be seen during regional blocks in humans. METHODS: Large-White swine were anesthetized with thiopental, followed by endotracheal intubation and controlled mechanical ventilation. Hemodynamic parameters included non-invasive blood pressure and catheterization of the pulmonary artery. After 30 minutes, animals were randomly divided into two groups, and 4 mg.kg-1 of one of the agents was administered intravenously without the knowledge of the investigator. Hemodynamic parameters were evaluated at rest and 1, 5, 10, 15, 20, and 30 minutes after intoxication. RESULTS: The hemodynamic repercussions of acute bupivacaine intoxication were more important and prolonged than in ropivacaine intoxication. With bupivacaine, the cardiac index showed greater and more prolonged reduction, mean arterial pressure and heart rate had more prolonged reduction, central venous pressure showed a more prolonged increase, and pulmonary wedge pressure increased more for more prolonged time. The impact on the systemic vascular resistance index showed that vasomotricity was partially maintained, increased in both groups, and, paradoxically, was greater and longer-lasting with bupivacaine. CONCLUSIONS: In swine, ropivacaine caused less hemodynamic repercussions than bupivacaine when the same doses were administered intravenously.

Keywords

ANESTHESIA, Local, ANESTHESIA, Local, COMPLICATIONS, COMPLICATIONS

References

Calatayud J, Gonzalez A. History of the development and evolution of local anesthesia since the coca leaf. Anesthesiology. 2003;98:1503-1508.

Ekenstam BA, Egner B, Petterson G. Local anaesthetics 1: Nalkyl pyrrolidine and N-alkyl piperidine carboxylic amides. Acta Chem Scand. 1957;11:1183-1190.

Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology. 1979;51:285-287.

Torres MLA. Toxicidade dos anestésicos locais: o debate continua!. Rev Bras Anestesiol. 2006;56:339-342.

Dony P, Dewinde V, Vanderick B. The comparative toxicity of ropivacaine and bupivacaine at equipotent doses in rats. Anesth Analg. 2000;91:1489-1492.

Reiz S, Haggmark S, Johansson G. Cardiotoxicity of ropivacaine: a new amide local anaesthetic agent. Acta Anaesthesiol Scand. 1989;33:93-98.

Scott DB, Lee A, Fagan D. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg. 1989;69:563-569.

Butterworth JF. Potency ratios of local anesthetics in regional blocks: how long must we wait?. Reg Anesth Pain Med. 2008;33:1-3.

Lefrant JY, Muller L, de la Coussaye JE. Hemodynamic and cardiac electrophysiologic effects of lidocaine-bupivacaine mixture in anesthetized and ventilated piglets. Anesthesiology. 2003;98:96-103.

Mather LE, Chang DH. Cardiotoxicity with modern local anaesthetics: is there a safer choice?. Drugs. 2001;61:333-342.

Groban L. Central nervous system and cardiac effects from long-acting amide local anesthetic toxicity in the intact animal model. Reg Anesth Pain Med. 2003;28:3-11.

Tasch MD, Butterworth JF. Toxicity of local anesthetics. ASA Refresher Courses Anesthesiol. 2006;34:165-179.

Reiz S, Nath S. Cardiotoxicity of local anaesthetics agents. Br J Anaesth. 1986;58:736-746.

Valenzuela C, Snyders DJ, Bennett PB. Stereoseletive block of cardiac sodium channels by bupivacaine in guinea-pig ventricular myocites. Circulation. 1995;92:3014-3024.

Lee-Son S, Wang GK, Concus A. Stereoselective inhibition of neuronal sodium channels by local anesthetics: evidence for two sites of action?. Anesthesiology. 1992;77:324-335.

Aya AGM, de la Coussaye JE, Robert E. Comparison of effects of racemic bupivacaine, levobupivacaine and ropivacaine on ventricular conduction, refractoriness and wavelength: an epicardial mapping study. Anesthesiology. 2002;96:641-650.

Mio Y, Fukuda N, Kusakari Y. Comparative effects of bupivacaine and ropivacaine on intracellular calcium transients and tension in ferret ventricular muscle. Anesthesiology. 2004;101:888-894.

Zink W, Bohl JRE, Hacke N. The long term myotoxic effects of bupivacaine and ropivacaine after continuous peripheral nerve blocks. Anesth Analg. 2005;101:548-554.

Åberg G. Toxicological and local anaesthetic effects of optically active isomers of two local anaesthetic compounds. Acta Pharmacol Toxicol. 1972;31:273-286.

Halpern SH, Walsh V. Epidural ropivacaine versus bupivacaine for labor: a meta- analysis. Anesth Analg. 2003;96:1473-1479.

Camorcia M, Capogna G, Columb MO. Minimum local analgesic doses of ropivacaine, levobupivacaine and bupivacaína for intrathecal labor analgesia. Anesthesiology. 2006;102:646-650.

Graf BM, Zausig Y, Zink W. Current status and clinical relevance of studies of minimum local-anaesthetic concentration (MLAC). Curr Opin Anaesthesiol. 2005;18:241-245.

Liisanantti O, Luukkonen J, Rosenberg PH. High-dose bupivacaine, levobupivacaine and ropivacaine in axillary brachial plexus block. Acta Anaesthesiol Scand. 2004;48:601-606.

Zink W, Graf BM. The toxicity of local anesthetics: the place of ropivacaine and levobupivacaine. Curr Opin Anaesthesiol. 2008;21:645-650.

Portella AAV, Oliveira LF, Machado CR. Injeção intravascular acidental de ropivacaína 1%: Relato de caso. Rev Bras Anestesiol. 2000;50:18-20.

Maranhão MVM, Vanon CC, Soares EO. Injeção intravascular acidental de ropivacaína: Relato de caso. Rev Bras Anestesiol. 2000;50:299-301.

Curtis FG, Furlani R, Castiglia YMM. Injeção intravascular acidental de ropivacaína a 0,5% durante a realização de anestesia peridural torácica: Relato de casos. Rev Bras Anestesiol. 2004;54:802-808.

Khoo LPY, Corbett AR. Successful resuscitation of an ASA 3 patient following ropivacaine-induced cardiac arrest. Anaesth Intensive Care. 2006;34:804-807.

Comparação das alterações hemodinâmicas na intoxicação aguda com bupivacaína e ropivacaína por via venosa em suínos

Comparison of hemodynamic changes in acute intoxication with intravenous bupivacaine and ropivacaine in swine

Marcos De Simone Melo; William Adalberto Silva; Ana Cristina de Moraes; Artur Udelsmann

Resumo

Palavras-chave

Abstract

Keywords

References

Links

Share

Braz J Anesthesiol