Abstract
Purpose
Unintentional intravascular bupivacaine injection is known to be associated with treatment-resistant cardiovascular collapse. Therefore, it is important for safe anesthetic management to establish an early sign of bupivacaine-induced cardiac depression with available monitoring. We hypothesized that bupivacaine induced-cardiac depression in dogs could be detected early by analyzing the electrocardiogram (ECG). We performed this study to investigate changes of ECG and ultimately find a variable reflecting cardiac output (CO) changes in dogs with bupivacaine-induced cardiac depression.
Methods
Bupivacaine was infused into pentobarbital-anesthetized dogs (n = 9) at a rate of 0.5 mg·kg-1·min-1 for 30 min. R-wave, S-wave and T-wave amplitudes in leads I, II and III were measured every five minutes after the start of bupivacaine infusion, and electrical axes of the heart were calculated at each time. The PR interval, QRS complex duration and corrected QT interval were also measured. CO, mean arterial blood pressure and heart rate were recorded at five-minute intervals. The relationships between CO and ECG wave parameters and of CO vs the hemodynamic variables were compared by correlation coefficients and regression analysis.
Results
The electrical mean axis of the heart was deviated to the left by the bupivacaine infusion. S-wave in lead III increased approximately twice within the first five minutes and showed the closest correlation with CO (r = 0.751, P < 0.001) during 30 min bupivacaine infusion.
Conclusion
Close monitoring of an ECG, and especially the Swave amplitude in lead III can be helpful for the early detection of bupivacaine-induced cardiac depression in dogs.
Résumé
Objectif
Ľinjection intravasculaire accidentelle de bupivacaïne est associée à un collapsus cardiovasculaire rebelle au traitement. Pour la sécurité de ľanesthésie, il faut donc définir, avec le monitorage disponible, un signe précoce de dépression myocardique induite par la bupivacaïne. Nous avons pensé que cette dépression pouvait être détectée tôt chez des chiens en analysant ľélectrocardiogramme (ECG). Nous voulions explorer les modifications de ľECG et, à la limite, trouver une variable montrant des changements de débit cardiaque (DC) chez des chiens atteints de dépression myocardique induite par la bupivacaïne.
Méthode
La bupivacaïne est perfusée chez des chiens anesthésiés au pentobarbital (n = 9) à 0,5 mg·kg-1·min-1 pendant 30 min. Ľamplitude des ondes R, S et T en D I, D II et D III est mesurée cinq minutes après le début de la perfusion et les axes électriques du cœur calculés à chaque fois. Ľintervalle PR, la durée du complexe QRS et ľintervalle QT corrigé sont aussi mesurés. Le DC, la tension artérielle moyenne et la fréquence cardiaque sont notés aux cinq minutes. La relation entre le DC et les paramètres des ondes de ľECG et entre le DC et les variables hémodynamiques est comparée par les coefficients de corrélation et ľanalyse de rľgression.
Résultats
Ľaxe électrique moyen du cœur a été dévié vers la gauche par la perfusion de bupivacaïne. Ľonde S en D III a augmenté approximativement du double pendant les cinq premières minutes et a montré la relation la plus étroite avec le DC (r = 0,751, P < 0,001) pendant 30 min de perfusion de bupivacaïne.
Conclusion
La surveillance étroite ďun ECG, spécialement de ľamplitude de ľonde S en D III, peut hâter la détection de la dépression myocardique induite par la bupivacaïne chez les chiens.
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Kim, JT., Jung, JY., Jung, CW. et al. S-wave in lead III is helpful for the early detection of bupivacaine-induced cardiac depression in dogs. Can J Anesth 52, 864–869 (2005). https://doi.org/10.1007/BF03021783
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DOI: https://doi.org/10.1007/BF03021783