Hemodynamic changes during continuous infusion of bupivacaine: Is early detection of bupivacaine toxicity possible?

Abstract

Objective: To investigate the hemodynamic effect of intravenous infusion of bupivacaine and examine the possibility of early detection of cardiotoxicity and preventing cardiac arrest in a rat model. Methods: Each experimental group was injected with prepared drugs and hemodynamic function was recorded. First, bupivacaine was infused continuously at a rate of 2 mg/kg/min. In the second experiment, when the left ventricular systolic pressure (LVSP) reached a maximal value during bupivacaine continuous infusion at 2 mg/kg/min, 20% Intralipid® was given as a 3 ml/kg bolus and continued as a 0.3 ml/kg/min infusion. In the third experiment, when the left ventricle reached maximal contracture during bupivacaine infusion at 2 mg/kg/min, the infusion was stopped. Results: Intravenous infusion of bupivacaine has biphasic hemodynamic effects with an initial increase in LVSP and subsequent cardiovascular collapse. Continuous infusion of bupivacaine induced cardiovascular collapse despite administration of Intralipid® after maximum LVSP was reached. When bupivacaine infusion was discontinued after reaching the maximum LVSP, hemodynamic function was maintained without cardiovascular collapse. Conclusion: Intravenous bupivacaine infusion increased the LVSP before cardiovascular collapse. Cardiovascular collapse can be prevented by close observation of hemodynamics and promptly discontinuing infusion of bupivacaine.