Insulin/glucose infusion successfully resuscitates bupivacaine-induced sudden-onset circulatory collapse in dogs.

Abstract

PURPOSE: In previous studies, insulin reversed the cardiac toxicity gradually induced by a continuous infusion of bupivacaine. In this randomized controlled study, we intended to simulate a more relevant clinical situation by injecting bupivacaine rapidly as a bolus to induce sudden-onset circulatory collapse in dogs. We then evaluated the insulin effect. METHODS: Bupivacaine (10 mg.kg(-1) iv) was rapidly administered intravenously to 12 dogs. At the onset of circulatory collapse (defined as a mean arterial pressure [MAP] of 30 mmHg), external chest compression was initiated. Insulin (2 U.kg(-1) iv) was given to the insulin-glucose (IG) group (n = 6) and the same volume of 0.9% saline was given to the control (C) group (n = 6). The primary outcome was successful resuscitation defined as both MAP ≥ 60 mmHg and sinus rhythm on an electrocardiogram that lasted ≥ 60 sec. Hemodynamic and blood variables were measured, including cardiac output and electrocardiogram intervals. RESULTS: All IG dogs were successfully resuscitated within 15 (3) min, whereas none of the control dogs were resuscitated (P = 0.002). After circulatory collapse, the average MAP was higher in group IG than in group C (P = 0.006). CONCLUSION: Insulin effectively reversed the sudden-onset circulatory collapse in dogs caused by an intravenous bolus injection of bupivacaine.