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Open Access Research article

The effects of levosimendan and dobutamine in experimental bupivacaine-induced cardiotoxicity

Ulku Kandemir1, Fikret Maltepe2*, Baran Ugurlu3, Necati Gokmen2 and Asli Celik4

Author Affiliations

1 Mus State Hospital, Clinic of Anaesthesia and Reanimation, (Formerly Dokuz Eylul University, Department of Anaesthesia and Reanimation, Izmir, Turkey), Mus, Turkey

2 Department of Anaesthesia and Reanimation, Dokuz Eylul University, Medical Faculty, Izmir, Turkey

3 Department of Cardiovasculary Surgery, Dokuz Eylul University, Medical Faculty, Izmir, Turkey

4 Department of Experimental Laboratory Animal Science, Dokuz Eylul University, Medical Faculty, Izmir, Turkey

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BMC Anesthesiology 2013, 13:28  doi:10.1186/1471-2253-13-28

Published: 3 October 2013

Abstract

Background

Accidental intravenous exposure to bupivacaine is highly cardiotoxic and may lead to death. Positive inotropic agents are usually utilized in resuscitative efforts. We have compared the efficacy of levosimendan, a novel inotropic agent, with dobutamine and their combination in a rat model of bupivacaine intoxication.

Methods

Twenty-eight male Wistar albino rats weighing between 250-300 g were divided into these four groups: control (C), levosimendan (L), dobutamine (D) and dobutamine+levosimendan (D+L). Bupivacaine was administered at a dose of 3 mg/kg/min until cardiac arrest occurred or for 120 min. ECG, heart rate, blood pressure, arterial blood gases, and end tidal CO2 levels were monitored. Levosimendan was administered as a bolus of 12 μg/kg for 10 min and continued as an infusion at 0.3 μg/kg/min. Dobutamine was infused at a dose of 3 μg/kg/min. The time required for a 50% and 75% decrease in heart rate and blood pressure with a total time to cardiac arrest and bupivacaine dose for obtaining cardiac arrest were analyzed.

Results

Time periods for heart rate reductions of 50% and 75% were significantly longer in groups L (903, 1198 s), D (984, 1542 s) and L+D (1705, 3152 s) compared with the control group (345, 538 s p < 0.001). Median times to mean blood pressure reductions of 50% and 75% were 399 - 504 s in the control group, 1005 -1204 s in group L, 685 - 1009 s in group D and 1544- 2982 s in group L+D, and the difference was significant compared with the control group. Median time duration to asystole was 703 s in the control group compared with 1385 s in group L, 1789 s in group D and 3557 s in group L+D. Time to cardiac arrest was significantly higher in all 3 study groups. It was also significantly higher in the L+D group compared with both groups L and D separately.

Conclusion

A combination of dobutamine with levosimendan significantly increased survival times in this bupivacaine-induced toxicity rat model compared with the control, levosimendan, and dobutamine groups.

Keywords:
Bupivacaine; Cardiotoxicity; Levosimendan; Dobutamine; Rat