Journal Club Department of Anesthesiology

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Journal ClubDepartment of Anesthesiology

• Sponsored by Baxter Pharma

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Bupivacaine cardiotoxicity have we found a way
to treat it?

• Dr Leilani Doyle
• Dr Ivan Hsia
• Dr Kelly Shinkaruk

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Local anesthetic toxicity

• Systemic toxicity rare
• CNSgtCVS
• Decreasing frequency w/
• introduction safety measures
• Newer safer drugs
• Incidence
• 12/100 000 epidural
• 200/100 000 brachial plexus blocks

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Local anesthetic toxicity

• Study in Japanese Society of Anesthesiologist
  Certified Training Hospital
• 4,291,925 anesthetics
• Frequency of LA toxicity 1.17/100 000 anesthetics
  delivered
• Fatality 0.023/100 000
• Very rare but catastrophic

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LA-induced cardiotoxicity

• LA exert
• direct effect
• Heart
• BVs
• Indirect effect on circulation
• Blocking SNS or PNS efferent activity
• All LA exert a dose-dependant (-) ionotropic
  action on cardiac muscle
• Proportional to conduction-blocking property of
  LA
• Bupivacainegtlidocaine cardiodepressant

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LA-induced cardiotoxicity

• 10 cardiac electrophysiologic effect
• Decrease rate of depolarization in
  fast-conducting tissues
• Purkinje
• Ventricular muscle
• Believed to be due to decrease in availability of
  fast sodium channels in cardiac membranes
• LA may depress myocardial contractility by
  affecting calcium influx trigger and release

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Bupivacaine-induced cardiotoxicity

• Evidence to support relationship between CNS and
  cardiotoxic effect
• Injection of bupivacaine into certain regions of
  the brain resulted development of cardiac
  arrhythmias