Mauch Jacqueline, Jurado Olga Martin, Spielmann Nelly, Bettschart-Wolfensberger Regula, Weiss Markus
Department of Anesthesiology, University Children's Hospital Zurich, Zurich, Switzerland.
Paediatr Anaesth. 2012 Feb;22(2):124-9. doi: 10.1111/j.1460-9592.2011.03688.x. Epub 2011 Aug 29.
Local anesthetic (LA) intoxication with cardiovascular arrest is a potential fatal complication of regional anesthesia. Lipid resuscitation has been recommended for the treatment of LA-induced cardiac arrest. Aim of the study was to compare four different rescue regimens using epinephrine and/or lipid emulsion and vasopressin to treat cardiac arrest caused by bupivacaine intoxication.
Twenty-eight piglets were randomized into four groups (4 × 7), anesthetized with sevoflurane, intubated, and ventilated. Bupivacaine was infused with a syringe driver via central venous catheter at a rate of 1 mg·kg(-1)·min(-1) until circulatory arrest. Bupivacaine infusion and sevoflurane were then stopped, chest compression was started, and the pigs were ventilated with 100% oxygen. After 1 min, epinephrine 10 μg·kg(-1) (group 1), Intralipid(®) 20% 4 ml·kg(-1) (group 2), epinephrine 10 μg·kg(-1) + Intralipid(®) 4 ml·kg(-1) (group 3) or 2 IU vasopressin + Intralipid(®) 4 ml·kg(-1) (group 4) were administered. Secondary epinephrine doses were given after 5 min if required.
Survival was 71%, 29%, 86%, and 57% in groups 1, 2, 3, and 4. Return of spontaneous circulation was regained only by initial administration of epinephrine alone or in combination with Intralipid(®). Piglets receiving the combination therapy survived without further epinephrine support. In contrast, in groups 2 and 4, return of spontaneous circulation was only achieved after secondary epinephrine rescue.
In cardiac arrest caused by bupivacaine intoxication, first-line rescue with epinephrine and epinephrine + Intralipid(®) was more effective with regard to survival than Intralipid(®) alone and vasopressin + Intralipid(®) in this pig model.
局部麻醉药（LA）中毒伴心血管骤停是区域麻醉潜在的致命并发症。脂质复苏已被推荐用于治疗LA诱导的心脏骤停。本研究的目的是比较四种不同的抢救方案，使用肾上腺素和/或脂质乳剂以及血管加压素治疗布比卡因中毒引起的心脏骤停。
28只仔猪随机分为四组（4×7），用七氟醚麻醉，插管并通气。通过中心静脉导管以1mg·kg⁻¹·min⁻¹的速率用注射器泵输注布比卡因，直至循环骤停。然后停止布比卡因输注和七氟醚，开始胸外按压，并用100%氧气对猪进行通气。1分钟后，给予肾上腺素10μg·kg⁻¹（第1组）、20%脂质乳剂4ml·kg⁻¹（第2组）、肾上腺素10μg·kg⁻¹+脂质乳剂4ml·kg⁻¹（第3组）或2IU血管加压素+脂质乳剂4ml·kg⁻¹（第4组）。如有需要，5分钟后给予第二次肾上腺素剂量。
第1、2、3和4组的存活率分别为71%、29%、86%和57%。仅通过最初单独给予肾上腺素或与脂质乳剂联合使用才能恢复自主循环。接受联合治疗的仔猪在无需进一步肾上腺素支持的情况下存活。相比之下，在第2组和第4组中，仅在第二次肾上腺素抢救后才实现自主循环恢复。
在本猪模型中，对于布比卡因中毒引起的心脏骤停，就存活率而言，肾上腺素和肾上腺素+脂质乳剂一线抢救比单独使用脂质乳剂和血管加压素+脂质乳剂更有效。
