ArticleAnaesthesiology intensive therapy2024
Sevoflurane reduces the cardiac toxicity of bupivacaine compared with propofol in rabbits: an experimental study using early electrocardiographic detection and measurement of toxic plasma concentration.
Article in Anaesthesiology intensive therapy, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe effect of both propofol and sevoflurane on bupivacaine cardiac toxi-city has not been conclusively defined. The goal of this study was to investigate the effects of propofol vs sevoflurane general anesthesia (GA) on bupivacaine-induced arrhyth-mias. MATERIAL AND
methodsTen rabbits were randomized to two groups: propofol- or sevoflurane-based GA. At the maintenance stage of anesthesia heart rate and QRS/QT durations were recorded as "baseline" and an intravenous (i.v.) bupivacaine 0.25% infusion at the rate of 1.0 mg kg -1 min -1 was initiated. Blood samples were obtained when predefined electrocardiographic (ECG) changes were observed and when the heart rate (HR) reached 75%, 50%, and 25% of the baseline and 0 bpm.
resultsThe mean time to first predefined ECG changes was 131 ± 25.02 s for the propofol group and 223 ± 34.11 s for the sevoflurane group ( P = 0.001). Time of progression of bradycardia in both groups was evaluated as a percentage of the initial HR for the understanding of the dynamics of changes during the local anesthetic systemic toxicity (LAST). The 25% HR time was shorter for the propofol group (480 ± 117 vs. 673 ± 146 s, P = 0.05). Time to asystole was shorter in the propofol group (110.7 ± 22.22 vs. 226.6 ± 98.61 s, P = 0.047). Mean serum bupivacaine concentration was lower for the propofol group during the occurrence of the first ECG changes (2.542 ± 1.415 vs. 6.997 ± 2.197 mg mL -1 , P = 0.005) and asystole (110.7 ± 22.22 vs. 226.6 ± 98.61 mg mL -1 , P = 0.047).
conclusionsIt seems that sevoflurane-, but not propofol-based anesthesia reduces the risk of LAST during GA combined with peripheral nerve blocks. Sevoflurane-based anesthesia may protect the myocardium from the toxic effects of bupivacaine.
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