Treatment of bupivacaine toxicity includes:
B i.e. Epinephrine, C i.e. Bretylium, A i.e. Isoproterenol Bupivacaine (R, +) isomer avidly blocks cardiac sodium channels & dissociates very slowly; its prolonged & high degree of protein binding makes resuscitation difficult & prolonged. At higher doses calcium & potassium channels are also blocked. Bupivacaine is more cardiotoxic than levobupivacaine, ropivacaine and lidocaine, paicularly in presence of acute respiratory acidosis, hypoxemia, hypercapnia in pregnancy (>>) and young children. - Amiodarone and possibly bretylium should be considered as preferred alternative to lidocaine in the treatment of LA induced ventricular tachyarrhythmias. Vasopressors may include epinephrine, norepinephrine and vasopressinQ. IsoproterenolQ may effectively reverse some of electrophysiological abnormalities characteristic of bupivacaine toxicity. - If LA intoxication produces cardiac arrest, the ACLS (advanced cardiac life suppo) guidelines are reasonable; however, I suggest that amiodarone & vasopressin be preferredQ/substituted for lidocaine & epinephrine (ACLS prefers epinephrine) - Morgan/273. With unresponsive bupivacaine toxicity, intravenous lipid infusion (remarkable ability to effect resuscitation from overdose even after 10 min of unsuccessful conventional resuscitation) or cardiopulmonary bypass may be considered. Calcium channel blockers are not recommended as these exaggerate the cardiodepressant effectsQ.
Isoproterenol
Epinephrine
Bretylium
All