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Comparative Regimens of Lipid Rescue From Bupivacaine-Induced Asystole in a Rat Model

Liu, Le, MD*; Jin, Zhousheng, MD*; Cai, Xixi, BS*; Xia, Yun, MD, PhD; Zhang, Meiling, PhD; Papadimos, Thomas J., MD, MPH§; Xu, Xuzhong, MD*; Shi, Kejian, MD*

doi: 10.1213/ANE.0000000000003711
Preclinical Pharmacology: Original Laboratory Research Report

BACKGROUND: It is currently unknown whether bupivacaine-induced asystole is better resuscitated with lipid emulsion (LE) administered peripherally or centrally, and whether different LE regimens administered peripherally demonstrated similar effects. In this study, we compared the effects of various regimens of lipid administration in a rat model of bupivacaine-induced asystole.

METHODS: Forty-five adult male Sprague-Dawley rats were subjected to bupivacaine-induced asystole and randomly divided into 3 lipid regimens groups: (1) 20% LE was administered continuously via the internal jugular vein (CV-infusion group); (2) 20% LE was administered continuously via the tail vein (PV-infusion group); and (3) 20% LE was administered as divided boluses via the tail vein (PV-bolus group). The maximum dose of LE did not exceed 10 mL·kg−1. External chest compressions were administered until the return of spontaneous circulation (ROSC) or the end of a 40-minute resuscitation period.

RESULTS: The survival rate, rate of ROSC, systolic blood pressure, heart rate, heart rate–blood pressure product, and coronary perfusion pressure during 2–40 minutes in the CV-infusion and PV-bolus groups were significantly higher than those in the PV-infusion group (P < .01), and the plasma total bupivacaine concentration and myocardial bupivacaine content were significantly lower (P < .05). Time to heartbeat return and time to ROSC in the CV-infusion and PV-bolus groups were significantly shorter than those in the PV-infusion group (P < .05).

CONCLUSIONS: In the rat model of bupivacaine-induced asystole, a divided LE bolus regimen administered peripherally provided a better resuscitation outcome than that of a continuous LE infusion regimen peripherally, and performed in a similar fashion as the continuous LE infusion regimen administered centrally.

From the *Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China

Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio

Analytical and Testing Center, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China

§Department of Anesthesiology, The University of Toledo College of Medicine and LifeSciences, Toledo, Ohio.

Published ahead of print 3 July 2018.

Accepted for publication July 3, 2018.

Funding: This work was supported by funds from the National Natural Science Foundation of China (81470419, Beijing, China) and by Wenzhou Science and Technology Bureau (Y20130206, Wenzhou, China).

The authors declare no conflicts of interest.

L. Liu and Z. Jin contributed equally and share first authorship.

Reprints will not be available from the authors.

Address correspondence to Kejian Shi, MD, Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, South Baixiang Town, Wenzhou, Zhejiang, China. Address e-mail to wzshikejian@163.com; and Xuzhong Xu, MD, Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, South Baixiang Town, Wenzhou, Zhejiang, China. Address e-mail to xuzhong@263.net.

© 2019 International Anesthesia Research Society
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