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Korean J Crit Care Med > Volume 19(2); 2004 > Article
Korean Journal of Critical Care Medicine 2004;19(2): 86-97.
원저 : 부피바케인과 레보부피바케인으로 심장혈관 허탈을 유도한 개에서 혈류역학의 비교
정철우, 김진태, 최윤숙, 배성심, 김지애, 조현성, 이국현
서울대학교 의과대학 마취과학교실, *성균관대학교 의과대학 마취과학교실
Hemodynamic Comparison between Bupivacaine and Levobupivacaine Induced Cardiovascular Collapses in Anesthetized Dogs
Chul Woo Jung, Jin Tae Kim, Yun Suk Choe, Seng Sim Bae, Jie Ae Kim, Hyun Sung Cho, Kook Hyon Lee
1Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea. leekh@plaza.snu.ac.kr
2Department of Anesthesiology, Sungkyunkwan University School of Medicine, Seoul, Korea.
BACKGROUND: Levobupivacaine is known to be less cardiotoxic than racemic bupivacaine but some authors have reported there were no differences in cardiotoxic profiles between two agents. We will investigate the full course to cardiovascular collapse induced by bupivacaine stereoisomers in anesthetized dogs and would find out the differences if any, and explain the causative factors. METHODS: Twenty dogs were assigned to two groups, racemic bupivacaine group (BUP) and levobupivacaine group (LBUP), equally (n=10, each). Under general anesthesia each drug was infused continuously (0.5 mg/kg/min) until cardiovascuar collapse (CVC, MAP=40 mmHg) occurred. During the experiment, hemodynamic data, CO, SVR, PVR, ECG parameters and drug concen tration were gathered and analyzed. RESULTS: Two groups were not different in terms of dose for CVC, plasma drug concentration and time for CVC. MAP maintained initial values during the early period and declined during the late period without any between-group difference. Otherwise CO decreased continuously and significantly higher in LBUP than in BUP throughout. Calculated SVR showed the same feature as CO in opposite direction and was higher in BUP. Correlation test revealed high correlation between CONC and SVR or PVR and between CO and cSvO2. CONCLUSIONS: In assessment of cardiovascular collapse induced by stereoisomers of bupivacaine, monitoring with only MAP can lead to misinterpretation and invasive monitoring including CO or cSvO2 measurement might be needed.
Key Words: Bupivacaine; Cardiovascular collapse; Levobupivacaine; Stereoisomer
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