Bupivacaine Toxicity

Paper Summary:

In this article, the writer notes that the roots of modern anesthetics may be traced back to the 19th century, with the successful isolation of cocaine from coca leaves. The writer points out that one type of amino amide that is far less toxic than cocaine is bupivacaine, which was eventually synthesized in 1963. The writer maintains that the long-lasting anesthetic effects provided by bupivacaine have been shown to cause cardiovascular toxicity at relatively low serum levels that are approximately the same as levels that cause toxicity in the central nervous system. The writer then discusses issues related to toxicity caused by the bupivacaine including reactions, prevention and resuscitation techniques. The writer concludes that the research supports possible clinical interventions using lipid infusion in the treatment of cardiac toxicity due to exposure to bupivacaine.

Outline:
The Development and Use of Bupivacaine
Toxic Reactions Associated with Bupivacaine
Case Studies Detailing Toxicity Associated with Bupivacaine
The Prevention of Bupivacaine-induced Toxicity
Bupivacaine and Positive Cardiovascular Effects?
Resuscitation Techniques Following Bupivacaine Intoxication
Lipid Infusion as Resuscitation for Bupivacaine Toxicity

From the Paper:

"Overall, bupivacaine is considered to be among anesthetic agents that are more likely to cause states of cardiotoxicity. In animal studies, bupivacaine was demonstrated to be four to sixteen times more likely to cause cadiovacular toxicity than lidocaine. However, bupivacaine will continue to remain as a primary local anesthetic agent used by clinicians, which indicates a need for knowledge and awareness as to how to most effectively treat toxicity when it arises."
"Clinicians must adhere to proper dosages of anesthetics and correct sites of administration in order to reduce chances of the occurrence of toxicity. More recently, research has yielded the development of anesthetic agents that have reduced toxicity in comparison to bupivacaine."

Sample of Sources Used:

• Bania, T.C., Chu, J., Perez, E., Su, M., Hahn, I.H. (2007). Hemodynamic effects of intravenous fat emulsion in an animal model of severe verapamil toxicity resuscitated with atropine, calcium, and saline. Academic Emergency Medicine, 14(2), 105-11.
• Bilir, A., Yelken, B., Kaygisiz, Z., Senturk, Y. (2006). The effects of dopexamine in bupivacaine and ropivacaine induced cardiotoxicity in isolated rat heart. Saudi Medical Journal, 27(8), 1194-8.
• Dony, P., Dewinde, V., Vanderick, B., Cuignet, O., Gautier, P., Legrand, E., Lanadhomme, P., De Kock, M. (2000). The comparative toxicity of ropivacaine and bupivacaine at equipotent doses in rats. Anesthesia and Analgesia, 91(6), 1489-92.
• Favier, J.C., Da Conceicao, M., Fassassi, M., Allanic, L., Steiner, T., Pitti, R. (2003). Successful resuscitation of serious bupivacaine intoxication in a patient with pre-existing heart failure. Canadian Journal of Anaesthesiology, 50(1), 62-6.
• Graf, B.M. (2001). The cardiotoxicity of local anesthetics: the place of ropivacaine. Current Topics in Medicinal Chemistry, 1(3), 207-14.

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