Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
Reg Anesth Pain Med. 2010 Jan-Feb;35(1):34-40. doi: 10.1097/aap.0b013e3181c69909.
Levosimendan, an inodilator without proarrhythmogenic properties, has been shown to reverse ropivacaine-induced negative inotropy in isolated heart preparations. In this randomized and blinded study, we investigated whether levosimendan is able to reverse rapidly bupivacaine-induced myocardial depression in pigs.
Twenty invasively monitored pigs anesthetized with isoflurane 1% received bupivacaine 2 mg/kg per minute into a central vein until mean arterial pressure decreased to 55% of baseline. Thereafter, levosimendan 80 microg/kg for 10 mins, followed by 0.7 microg/kg per minute during the next 50 mins (L-SIM) or corresponding amounts of placebo were administered intravenously. Simultaneously, Ringer's acetate was infused intravenously, 20 mL/kg for 10 mins, followed by 20 mL/kg for 50 mins.
Two pigs in each group developed cardiac arrest immediately after bupivacaine and could not be resuscitated. Bupivacaine induced widening of the QRS complex in the electrocardiogram and bradycardia.In the remaining 16 pigs, 3 (2 in L-SIM group and 1 in placebo group) needed short-lasting manual cardiac compression and 1 dose of epinephrine. Cardiac output, ejection fraction, and stroke power/end-diastolic volume recovered initially very rapidly in the L-SIM group.However, there was no time x group effect difference in the overall recovery in the various parameters between the 2 groups, except in heart rate which was higher (P G 0.05) when levosimendan was administered.During the 50-min levosimendan infusion, mean arterial pressure and systemic vascular resistance stayed slightly lower in comparison with placebo infusion, but the difference was not statistically significant.
Levosimendan together with the infusion of Ringer's solution rapidly reversed the cardiac depression, but there was no difference in overall cardiovascular recovery in comparison to treatment with Ringer's solution alone. Levosimendan-induced increase in heart rate possibly facilitated the recovery from bupivacaine intoxication.
左西孟旦是一种无致心律失常特性的正性肌力药物，已被证明可逆转分离心脏制剂中罗哌卡因引起的负性肌力作用。在这项随机、盲法研究中，我们研究了左西孟旦是否能够快速逆转布比卡因引起的猪心肌抑制。
20 只接受 1%异氟烷麻醉的有创监测猪静脉内输注布比卡因 2mg/kg/min，直至平均动脉压降至基线的 55%。此后，静脉内给予左西孟旦 80μg/kg 10min，随后在接下来的 50min 内给予 0.7μg/kg/min（L-SIM）或相应剂量的安慰剂。同时，静脉内输注醋酸林格氏液，10min 内输注 20mL/kg，然后 50min 内输注 20mL/kg。
每组各有 2 只猪在输注布比卡因后立即发生心脏骤停，无法复苏。布比卡因引起心电图 QRS 波群增宽和心动过缓。在其余 16 只猪中，有 3 只（L-SIM 组 2 只，安慰剂组 1 只）需要短暂的手动心脏按压和 1 次肾上腺素。在 L-SIM 组，心输出量、射血分数和每搏功/舒张末期容积在最初恢复非常迅速。然而，在 2 组之间，除心率（给予左西孟旦时更高，P<0.05）外，在各种参数的总体恢复方面没有时间×组效应差异。在 50min 左西孟旦输注期间，与安慰剂输注相比，平均动脉压和全身血管阻力略有降低，但差异无统计学意义。
左西孟旦联合林格氏液输注可迅速逆转心脏抑制，但与单独使用林格氏液相比，总体心血管恢复无差异。左西孟旦引起的心率增加可能有助于从布比卡因中毒中恢复。
