Mauch Jacqueline, Martin Jurado Olga, Spielmann Nelly, Bettschart-Wolfensberger Regula, Weiss Markus
Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland.
Paediatr Anaesth. 2011 Nov;21(11):1103-8. doi: 10.1111/j.1460-9592.2011.03652.x. Epub 2011 Jul 18.
Local anesthetic (LA) intoxication with severe hemodynamic compromise is a potential catastrophic event. Lipid resuscitation has been recommended for the treatment of LA-induced cardiac arrest. However, there are no data about effectiveness of Intralipid for the treatment of severe cardiovascular compromise prior to cardiac arrest. Aim of this study was to compare effectiveness of epinephrine and Intralipid for the treatment of severe hemodynamic compromise owing to bupivacaine intoxication.
Piglets were anesthetized with sevoflurane, intubated, and ventilated. Bupivacaine was infused with a syringe driver via a central venous catheter at a rate of 1 mg·kg(-1) ·min(-1) until invasively measured mean arterial pressure (MAP) dropped to 50% of the initial value. Bupivacaine infusion was then stopped, and epinephrine 3 μg·kg(-1) (group 1), Intralipid(®) 20% 2 ml·kg(-1) (group 2), or Intralipid 20% 4 ml·kg(-1) (group 3) was immediately administered. Survival, hemodynamic course, and ET(CO2) were recorded.
Twenty-one piglets (3 × 7), with median age of 26 days (19-43) and weighing 4.9 kg (4.3-5.8), were investigated. All animals in group 1 (100%) but only four of seven (57%) piglets in group 2 and group 3, respectively, survived. Normalization of hemodynamic parameters (HR, MAP) and ET(CO2) was fastest in group 1 with all piglets achieving HR and MAP values at or above baseline within 1 min.
For the treatment of severe hemodynamic compromise owing to bupivacaine intoxication in piglets, first-line rescue with epinephrine was more effective than Intralipid with regard to survival as well as normalization of hemodynamic parameters and ET(CO2) .
局部麻醉药（LA）中毒伴严重血流动力学损害是一种潜在的灾难性事件。脂质复苏已被推荐用于治疗LA引起的心脏骤停。然而，关于在心脏骤停前使用脂质乳剂治疗严重心血管损害的有效性尚无数据。本研究的目的是比较肾上腺素和脂质乳剂治疗布比卡因中毒所致严重血流动力学损害的有效性。
仔猪用七氟醚麻醉，插管并进行机械通气。通过中心静脉导管用注射器泵以1mg·kg⁻¹·min⁻¹的速率输注布比卡因，直至有创测量的平均动脉压（MAP）降至初始值的50%。然后停止布比卡因输注，并立即给予肾上腺素3μg·kg⁻¹（第1组）、20%脂质乳剂2ml·kg⁻¹（第2组）或20%脂质乳剂4ml·kg⁻¹（第3组）。记录生存率、血流动力学过程和呼气末二氧化碳分压（ET(CO2)）。
对21头仔猪（3×7）进行了研究，中位年龄为26天（19 - 43天），体重4.9kg（4.3 - 5.8kg）。第1组的所有动物（100%）存活，但第2组和第3组分别只有7头仔猪中的4头（57%）存活。第1组血流动力学参数（心率、MAP）和ET(CO2)的恢复正常最快，所有仔猪在1分钟内心率和MAP值达到或高于基线。
对于治疗仔猪布比卡因中毒所致严重血流动力学损害，在生存率以及血流动力学参数和ET(CO2)恢复正常方面，肾上腺素作为一线抢救药物比脂质乳剂更有效。
