Bertrix L, Timour Q, Mazze R I, Freysz M, Samii K, Faucon G
Claude Bernard University, Lyon, France.
Anesth Analg. 1991 Oct;73(4):434-40. doi: 10.1213/00000539-199110000-00012.
Regional anesthesia with bupivacaine in pediatric patients is often accompanied by light levels of halothane general anesthesia. To determine the potential cardiotoxicity of these two drugs when used together, we defined the interaction between moderate plasma bupivacaine concentrations (1270-1760 ng/mL) and halothane (end-tidal concentrations, 0.5%-1.0%) on ventricular contractility and conduction in 22 closed-chest dogs anesthetized with chloralose. Bupivacaine alone (1-mg/kg intravenous bolus plus a 0.1-mg.kg-1.min-1 constant rate infusion) resulted in significant increases in ventricular conduction time (VCT) and effective refractory period (VERP) and nonsignificant decreases in dP/dtmax and blood pressure. The addition of halothane resulted in hypotension and in progressively increasing plasma bupivacaine levels secondary to reduced hepatic clearance, which led to further dose-related significant increases in VCT and VERP and to significant decreases in dP/dtmax and blood pressure. In other dogs given halothane but in which bupivacaine levels were held constant (1400 ng/mL), VCT remained constant and VERP lengthened slightly, whereas dP/dtmax decreased. We conclude that the combination of bupivacaine and halothane can cause adverse effects on ventricular contractility and intraventricular conduction.
小儿患者使用布比卡因进行区域麻醉时，常伴有低浓度的氟烷全身麻醉。为了确定这两种药物联合使用时的潜在心脏毒性，我们在22只使用水合氯醛麻醉的开胸犬中，研究了中等血浆布比卡因浓度（1270 - 1760 ng/mL）与氟烷（呼气末浓度，0.5% - 1.0%）对心室收缩性和传导的相互作用。单独使用布比卡因（静脉推注1 mg/kg，随后以0.1 mg·kg⁻¹·min⁻¹持续输注）导致心室传导时间（VCT）和有效不应期（VERP）显著增加，而dP/dtmax和血压无显著下降。添加氟烷导致低血压，并因肝清除率降低而使血浆布比卡因水平逐渐升高，进而导致VCT和VERP进一步呈剂量相关的显著增加，以及dP/dtmax和血压显著下降。在其他给予氟烷但布比卡因水平保持恒定（1400 ng/mL）的犬中，VCT保持不变，VERP略有延长，而dP/dtmax下降。我们得出结论，布比卡因和氟烷联合使用可对心室收缩性和心室内传导产生不利影响。
