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[Do beta adrenergic receptor blockaders increase bupivacaine cardiotoxicity?]
J E de La Coussaye1, J J Eledjam, J Brugada
1Département d'Anesthésie-Réanimation, Hôpital Carémeau, CHR Nîmes.
Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1990
Summary
Pre-existing beta-adrenergic receptor blockade in dogs worsened the cardiac and circulatory effects of toxic bupivacaine doses. This led to increased heart rate decrease, atrioventricular conduction time, and hypotension, with some animals experiencing cardiac arrest.
Area of Science:
- Cardiology
- Pharmacology
- Anesthesiology
Context:
- Bupivacaine, a local anesthetic, can negatively impact cardiac electrophysiology and hemodynamics.
- Calcium channel blockers are known to exacerbate bupivacaine's cardiotoxicity.
- The effects of bupivacaine toxicity in the context of beta-adrenergic receptor blockade require further investigation.
Purpose:
- To assess the cardiotoxic effects of a toxic bupivacaine dose in dogs previously treated with propranolol, a beta-adrenergic receptor blocker.
- To compare the hemodynamic and electrophysiological changes induced by bupivacaine in control dogs versus dogs with prior beta-blockade.
Summary:
- Twelve anesthetized dogs were divided into a control group receiving bupivacaine and a study group receiving propranolol followed by bupivacaine.
- Both groups showed worsened infranodal conduction; however, the propranolol group exhibited a significantly greater decrease in heart rate, prolonged atrioventricular conduction time, and severe hypotension.
- Three dogs in the study group experienced cardiac arrest, indicating that prior beta-blockade potentiates bupivacaine's adverse cardiovascular effects.
Impact:
- This study demonstrates that preexisting beta-adrenergic receptor blockade significantly increases the cardiac and circulatory risks associated with toxic bupivacaine administration in anesthetized dogs.
- Findings suggest caution when using bupivacaine in patients with compromised beta-adrenergic function.
- Highlights the complex interactions between local anesthetics and cardiovascular medications.