Treatment of bupivacaine toxicity includes: (PGI May 2011)
Ans: C (Bretylium) TREATMENT OF BUP1VACA1NE INDUCED CARDIOTOXIC1TY MILLER 6TH/933"Many resuscitation drugs, including atropine, epinephrine, bretylium, lidocaine, amrinone, and phenytoin, have been used in animal studies and occasionally in humans for the treatment of bupivacaine overdose and cardiovascular collapse. In our view, beyond the established uses of epinephrine, vasopressin, and atropine in their designated steps in the advanced cardiac life support (ACLS) protocol and beyond the use of Intralipid as detailed later, there is no established role for anti arrhythmic drugs or other traditional resuscitation drugs in the setting of bupivacaine-induced cardiac arrest It is not recommended that bupivacaine-induced ventricular arrhythmias be treated with iidocaine or amiodaroneThe clinical implications for cardiac resuscitation after intravascular injection or overdose of local anesthetic are the following: Miller 6th/933No medications are uniformly effective in facilitating resuscitation from bupivacaine-induced cardiac arrest or severe ventricular tachycardia. Basic principles of cardiopulmonary resuscitation should be emphasized first, including attention to securing the airway; providing oxygenation and ventilation, and performing chest compressions if needed.Because resuscitation after local anesthetic-induced circulatory collapse is so difficult, prevention of massive intravascular injection or excessive dosing is crucial.Negative aspiration of the syringe does not always exclude intravascular placement, incremental, fractionated dosing should be the rule for all patients undergoing major conduction blockade. Although changes on the ECG are not always present before circulatory collapse, they often are, and continuous attention to the ECG (including changes in QRS morphology, rate, rhythm, or ectopy) may be lifesaving by terminating injection before a lethal dose is administered.If a patient experiences profound cardiovascular depression or circulatory arrest after the administration of bupivacaine, ropivacaine, or by extrapolation, other local anesthetics, then along with initiation of basic life support and theACLS protocol we support the recommendation of Weinberg and colleagues that a rapid bolus of Intralipid 20%<t\ 1.5 mL/kg (or roughly 100 mL in adults), be administered without delay, followed if necessary by an infusion of 0.25 mL/kg/min for the next 10 minutesTreatment of Bupivacaine Induced Cardiotoxicity Barash Anesthesia 6th/545"Potent local anesthetics (e.g., bupivacaine! can produce profound cardiovascular depression and malignant dysrhythmias that should be promptly treated. Oxygenation and ventilation must be immediately instituted, with cardiopulmonary resuscitation if needed. Ventricular dysrhythmias may be difficult to treat and may need large and multiple doses of electrical cardioversion, epinephrine, vasopressin, and amiodarone. The use of calcium channel blockers in this setting is not recommended, as its cardiodepressant effect is exaggerated"A novel and promising treatment for cardiac toxicity is the administration of intravenous lipid to theoretically remove bupivacaine from sites of action. Administration of 100 mL of 20% lipid solution has been reported to allow successful resuscitation of a patient from bupivacaine-induced dysrhythmias refractory to conventional therapy.These findings raise the question of whether standard propofol in a 10% lipid solution would be a preferred treatment for cardiac toxicity. However, the dose of lipid in a standard induction dose of propofol would be too small and the dose of propofol would lead to unacceptable cardiac depression
Isoprenaline
Calcium channel blockers
Bretylium
Metoprolol
Miscellaneous (Local and Regional Anesthesia)