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Intralipid Restoration of Myocardial Contractions Following Bupivacaine-Induced Asystole: Concentration- and Time-Dependence In Vitro

 Park, Wyun Kon  ;  Kim, Hyun Soo  ;  Kim, Soo Hwan  ;  Jung, Ja Rang  ;  Lynch, Carl III  ;  Min, Nar Hyun 
 ANESTHESIA AND ANALGESIA, Vol.125(1) : 91-100, 2017 
Journal Title
Issue Date
Anesthetics, Local/adverse effects ; Animals ; Blood Pressure ; Bupivacaine/adverse effects* ; Emulsions/pharmacology ; Fat Emulsions, Intravenous/pharmacology ; Glycine/administration & dosage ; Glycine/analogs & derivatives ; Guinea Pigs ; Heart/drug effects* ; Heart Arrest/chemically induced* ; Heart Arrest, Induced/methods ; Lipids/pharmacology* ; Male ; Myocardial Contraction/drug effects* ; Myocardium/metabolism ; Phospholipids/pharmacology ; Rats, Sprague-Dawley ; Soybean Oil/pharmacology ; Time Factors
BACKGROUND: The concentration- and time-response relationships of lipid emulsion (LE; Intralipid) on the recovery of myocardial contractility following bupivacaine (BPV)-induced asystole are poorly defined.

METHODS: After achieving asystole by 500-μM BPV, varied concentrations of LE were applied to determine the recovery of stimulated contractile responses and contractions in the cardiac tissues of guinea pigs at a 1.2-Hz stimulation rate. These experiments were performed with LE in either a recirculating (2%-16%) or washout (nonrecirculating) condition (0.05%-12%) for 60 minutes. The effect of LE itself (0.05%-12%) was examined. Oxfenicine was used to evaluate the metabolic action of LE to reverse asystole. BPV concentrations in solution and myocardial tissues were measured.

RESULTS: In the recirculation condition, partial recovery of contractile forces was observed for 60 minutes at 4%, 8%, and 12% LE. A contracture followed after exposure to 16% LE in some asystolic muscles. In the washout experiments, following asystole, LE (0.05%-12%) had no effect on the recovery time of the first and regular contractile responses. LE (0.1%-8%) restored contractility to baseline levels after 45 minutes; partial recovery was shown with lower (0.05%) and higher (12%) concentrations. Oxfenicine did not alter the recovery of contractile forces. Contractile depression was observed with 12% LE alone. Concentration-related reduction of tissue BPV concentration by LE was observed in both circulating conditions.

CONCLUSIONS: LE induced time- and concentration-dependent recovery of stimulated myocardial contractions from BPV-induced asystole. The lipid uptake effect, along with other undefined mechanisms of LE, seems to contribute to the recovery of contractile function; however, the LE effect on myocardial metabolism is less likely involved at this concentration (500 μM) of BPV.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Min, Nar Hyun(민나현) ORCID logo https://orcid.org/0000-0003-2367-3489
Park, Wyun Kon(박윤곤)
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