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Anaesthesiology Intensive Therapy
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4/2024
vol. 56
 
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abstract:
Original article

Sevoflurane reduces the cardiac toxicity of bupivacaine compared with propofol in rabbits: an experimental study using early electrocardiographic detection and measurement of toxic plasma concentration

Nataliia Semenko
1
,
Iurii Kuchyn
1
,
Michael Frank
1
,
Kateryna Bielka
1
,
Demyd Milokhov
2
,
Olga Korshun
2

  1. Department of Surgery, Anesthesiology and Intensive Care, Bogomolets National Medical University, Kyiv, Ukraine
  2. Institute of Hygiene and Ecology, Bogomolets National Medical University, Kyiv, Ukraine
Anaesthesiol Intensive Ther 2024; 56, 4: 224–230
DOI: https://doi.org/10.5114/ait.2024.145167
Online publish date: 2024/11/29
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Background:
The effect of both propofol and sevoflurane on bupivacaine cardiac toxi­city has not been conclusively defined. The goal of this study was to investigate the effects of propofol vs sevoflurane general anesthesia (GA) on bupivacaine-induced arrhyth­mias.

Material and methods:
Ten rabbits were randomized to two groups: propofol- or sevoflurane-based GA. At the maintenance stage of anesthesia heart rate and QRS/QT durations were recorded as “baseline” and an intravenous (i.v.) bupivacaine 0.25% infusion at the rate of 1.0 mg kg–1 min–1 was initiated. Blood samples were obtained when predefined electrocardiographic (ECG) changes were observed and when the heart rate (HR) reached 75%, 50%, and 25% of the baseline and 0 bpm.

Results:
The mean time to first predefined ECG changes was 131 ± 25.02 s for the propofol group and 223 ± 34.11 s for the sevoflurane group (P = 0.001). Time of progression of bradycardia in both groups was evaluated as a percentage of the initial HR for the understanding of the dynamics of changes during the local anesthetic systemic toxicity (LAST). The 25% HR time was shorter for the propofol group (480 ± 117 vs. 673 ± 146 s, P = 0.05). Time to asystole was shorter in the propofol group (110.7 ± 22.22 vs. 226.6 ± 98.61 s, P = 0.047). Mean serum bupivacaine concentration was lower for the propofol group during the occurrence of the first ECG changes (2.542 ± 1.415 vs. 6.997 ± 2.197 mg mL–1, P = 0.005) and asystole (110.7 ± 22.22 vs. 226.6 ± 98.61 mg mL–1, P = 0.047).

Conclusions:
It seems that sevoflurane-, but not propofol-based anesthesia reduces the risk of LAST during GA combined with peripheral nerve blocks. Sevoflurane-based anesthesia may protect the myocardium from the toxic effects of bupivacaine.

keywords:

LAST, bupivacaine, propofol, sevoflurane
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