Jin Zhousheng, Xia Yun, Xia Fangfang, Wu Cong, Chen Zhe, Nan Fubei, Wu Bingjing, Wan Li, Wang Xianqin, Papadimos Thomas J, Xu Xuzhong
From the *Department of Anesthesiology, The First Affiliated Hospital, Wenzhou Medical University, Zhejiang, China; †Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH; and ‡Department of Pathology, The First Affiliated Hospital, Wenzhou Medical University; and §Analysis and Testing Center, Wenzhou Medical University, Zhejiang, China.
Reg Anesth Pain Med. 2015 May-Jun;40(3):223-31. doi: 10.1097/AAP.0000000000000220.
The medical community commonly uses lipid emulsion combined with epinephrine in local anesthetic-induced cardiac arrest, but the optimal timing of epinephrine administration relative to lipid emulsion is currently unknown and needs to be determined.
Thirty adult male Sprague-Dawley rats were subjected to bupivacaine-induced asystole and were then randomly divided into 3 groups. The temporal administration of epinephrine varied in each group: (1) immediately after the completion of the initial bolus of lipid emulsion therapy (postILE0); (2) immediately after cardiac arrest before the initial bolus of lipid emulsion (preILE); or (3) 1 minute after the completion of the initial bolus of lipid emulsion (postILE1). External chest compression was administered until the return of spontaneous circulation or the end of a 20-minute resuscitation period.
The postILE0, preILE, and postILE1 groups displayed different survival rates (100%, 30%, and 40%; P = 0.003). After return of spontaneous circulation, the rate-pressure product of the postILE0 group was higher than that of the postILE1 group (P < 0.001). Wet-to-dry lung weight ratio of preILE and postILE1 groups was higher than that of the postILE0 group (P < 0.05). The rate of damaged alveoli of the postILE0 group was lower than those of the preILE (P = 0.001) and postILE1 (P < 0.001) groups. Concentrations of bupivacaine in the cardiac tissues of the postILE0 group were lower than that of the postILE1 group (P = 0.01).
In the rat model of bupivacaine-induced cardiac arrest, the optimal timing for the administration of epinephrine to produce best outcomes of successful cardiopulmonary resuscitation is immediately after the completion of the lipid emulsion bolus. This optimal timing/therapeutic window is of paramount importance.
医学界通常在局部麻醉药引起的心脏骤停中使用脂质乳剂联合肾上腺素，但相对于脂质乳剂，肾上腺素给药的最佳时机目前尚不清楚，需要确定。
30只成年雄性Sprague-Dawley大鼠接受布比卡因诱导的心脏停搏，然后随机分为3组。每组肾上腺素给药时间不同：(1)脂质乳剂初始推注完成后立即给药（脂质乳剂初始推注后0分钟）；(2)心脏骤停后、脂质乳剂初始推注前立即给药（脂质乳剂初始推注前）；或(3)脂质乳剂初始推注完成后1分钟给药（脂质乳剂初始推注后1分钟）。进行胸外按压，直至自主循环恢复或20分钟复苏期结束。
脂质乳剂初始推注后0分钟、脂质乳剂初始推注前、脂质乳剂初始推注后1分钟组的生存率不同（分别为100%、30%和40%；P = 0.003）。自主循环恢复后，脂质乳剂初始推注后0分钟组的速率-压力乘积高于脂质乳剂初始推注后1分钟组（P < 0.001）。脂质乳剂初始推注前和脂质乳剂初始推注后1分钟组的肺湿重与干重之比高于脂质乳剂初始推注后0分钟组（P < 0.05）。脂质乳剂初始推注后0分钟组的肺泡损伤率低于脂质乳剂初始推注前（P = 0.001）和脂质乳剂初始推注后1分钟组（P < 0.001）。脂质乳剂初始推注后0分钟组心脏组织中的布比卡因浓度低于脂质乳剂初始推注后1分钟组（P = 0.01）。
在布比卡因诱导的心脏骤停大鼠模型中，为使心肺复苏成功获得最佳结果，肾上腺素给药的最佳时机是脂质乳剂推注完成后立即给药。这个最佳时机/治疗窗至关重要。
