Page 13 - 麻醉与监护论坛2015年第6期

Cover Thesis
Table 2 the side effects of different concentration of
bupivacaine hydrochloride
0.25% 0.3% 0.375% 0.5% 0.75%
1 - -- --
2 - ++ ++
3 + ++ ++
4 - -- --
5 - -- --
1.restlessness
2.conscious disturbance, cannot answer any questions, spasm
3.temporarily bradycardia
4.allergic responses
5.cardiotoxicity, lead to serious arrhythmia, hypotension, asystole, shock and death.
“+” means have the side effects, “-” means have no the side effects
to occur after accidental intravascular injection of
bupivicaine1-4 because of blocking many types of ion
channels5, 6. Bupivacaine hydrochloride has been used
clinically for 100 years. Its most important merits are
perfect and prolonged blocking, and its price is cheap
moreover. But since the cardiotoxicity reported1-4, the
employment of bupivacaine hydrochloride has been
reduced gradually. Some anesthesiologists dare not use
bupivacaine hydrochloride for scare of the cardiotoxicity.
Bupivacaine hydrochloride has been used in our anesthesia
department for 20 years according to the dosage and
concentration recommended and operating instructions.
Among the side effects, temporarily bradycardia could be
seen occasionally, no restlessness, allergic response and
serious cardiotoxicity were observed, few of cases who
were mistakenly injected bupivacaine hydrochloride into
blood vessels showed conscious disturbance and could
not answer any questions, spasm, but no cases showed
the cardiotoxicity.
Because we had not painstakingly recorded the side
effects of bupivacaine hydrochloride in every patient, we
could only provide the kinds of side effects, moreover, the
cardiotoxicity of bupivacaine hydrochloride as it has been
widely cared, has not been taken place.
Bupivacaine, as well as other local anesthetics, can
cause cardiovascular collapse when accidentally injected
Laboratory and ClinicalCIonverstTighaetsioisn
123
into blood vessels. In our experiences, if the injecting is
not too fast, it maybe not too dangerous after accidental
intravascular injecting because convulsion often show
at first and timely managements, such as 20% lipid and
pacemaker will be taken. Only one circumstance is not safe
that bupivacaine is injected under general anesthesia.
Conclusion
The severe cardiotoxicity of bupivacaine hydrochloride
maybe very scarce, the dosage and concentration as
recommended maybe very safe.
References
1 Albright GA. Cardiac arrest following regional anesthesia with
etidocaine or bupivacaine. Anesthesiology 1979; 51: 285-7.
2 Lacombe P, Blaise G, Lonlmet D, et al. Electrophysiologic effects
of bupivacaine in the isolated rebbit heart. Anesth Analg 1991;
72: 62-69.
3 Bruelle P, Lefrant JY, da La Conssaye JE, et al. Comparative
electrphysiologic and hemodynamic effects of several amide
local anesthetic drugs in anesthetized dogs. Anesth Analg 1996;
82: 648-656.
4 De La Conssaye JE, Bassoul BP, Albat B, et al. Succinylcholine
does not worsen bupivacaine-induced caidiotoxicity in
pentobarbital-anesthetized dogs. Can J Anaesth, 1992; 39:
192-197.
5 Clarkson CW, Hondeghem LM. Evidence for a specific receptor
site for lidocaine, quinidine and bupivacaine associated with
cardiac sodium channels in guinca pig ventricular myocardium.
Circ Res, 1985; 56: 496-506.
6 Lynch C. Depression of myocardial contractility in vitro by
bupivacain, etidocaine a dlidocaine. Anesth Analg, 1986; 65:
551-559.
23 FAM 2014 Jan/Feb Vol.21 Issue 1