Comparação das alterações hemodinâmicas na intoxicação aguda com bupivacaína e ropivacaína por via venosa em suínos

Marcos De Simone Melo; William Adalberto Silva; Ana Cristina de Moraes; Artur Udelsmann

doi:10.1590/S0034-70942009000500008

Scientific Article

Comparação das alterações hemodinâmicas na intoxicação aguda com bupivacaína e ropivacaína por via venosa em suínos

Comparison of hemodynamic changes in acute intoxication with intravenous bupivacaine and ropivacaine in swine

Marcos De Simone Melo; William Adalberto Silva; Ana Cristina de Moraes; Artur Udelsmann

http://dx.doi.org/10.1590/S0034-70942009000500008 Braz J Anesthesiol, vol.59, n5, p.592-601, 2009

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Resumo

JUSTIFICATIVA E OBJETIVOS: A ropivacaína apresentada na forma levógira pura foi introduzida para proporcionar alternativa mais segura que a bupivacaína nas anestesias locorregionais. O objetivo deste estudo foi comparar as repercussões hemodinâmicas após injeção por via venosa dos dois agentes em suínos, simulando intoxicação que pode ocorrer durante anestesia locorregional em humanos. MÉTODO: Suínos da raça Large-White foram anestesiados com tiopental, realizada intubação traqueal e instituída ventilação controlada mecânica. As variáveis hemodinâmicas foram medidas através de monitorização invasiva da pressão arterial e cateterização de artéria pulmonar. Após período de repouso de 30 minutos os animais foram aleatoriamente divididos em dois grupos e receberam por via venosa 4 mg.kg-1 de um ou outro agente sem conhecimento do pesquisador. Os resultados hemodinâmicos foram avaliados em repouso e 1, 5, 10, 15, 20 e 30 minutos após a intoxicação. RESULTADOS: As repercussões hemodinâmicas da intoxicação aguda com bupivacaína foram mais importantes e mais prolongadas do que as com ropivacaína. Com bupivacaína o índice cardíaco teve diminuição maior e mais prolongado, a pressão arterial média e a frequência cardíaca diminuições mais prolongadas, a pressão venosa central aumento mais prolongado e a pressão capilar pulmonar aumentou mais e por mais tempo. O impacto no índice de resistência vascular sistêmica mostrou que a vasomotricidade foi parcialmente mantida, houve aumento nos dois grupos e, paradoxalmente, maior e por mais tempo com bupivacaína. CONCLUSÕES: Em suínos a ropivacaína causou menos repercussões hemodinâmicas do que a bupivacaína quando as mesmas doses foram injetadas por via venosa.

Palavras-chave

ANESTESIA, Local, ANESTESIA, Local, COMPLICAÇÕES, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Pure levorotatory ropivacaine was introduced to provide a safer alternative to bupivacaine in regional blocks. The objective of this study was to compare the hemodynamic repercussions after the intravenous administration of both agents in swine, simulating the intoxication that can be seen during regional blocks in humans. METHODS: Large-White swine were anesthetized with thiopental, followed by endotracheal intubation and controlled mechanical ventilation. Hemodynamic parameters included non-invasive blood pressure and catheterization of the pulmonary artery. After 30 minutes, animals were randomly divided into two groups, and 4 mg.kg-1 of one of the agents was administered intravenously without the knowledge of the investigator. Hemodynamic parameters were evaluated at rest and 1, 5, 10, 15, 20, and 30 minutes after intoxication. RESULTS: The hemodynamic repercussions of acute bupivacaine intoxication were more important and prolonged than in ropivacaine intoxication. With bupivacaine, the cardiac index showed greater and more prolonged reduction, mean arterial pressure and heart rate had more prolonged reduction, central venous pressure showed a more prolonged increase, and pulmonary wedge pressure increased more for more prolonged time. The impact on the systemic vascular resistance index showed that vasomotricity was partially maintained, increased in both groups, and, paradoxically, was greater and longer-lasting with bupivacaine. CONCLUSIONS: In swine, ropivacaine caused less hemodynamic repercussions than bupivacaine when the same doses were administered intravenously.

Keywords

ANESTHESIA, Local, ANESTHESIA, Local, COMPLICATIONS, COMPLICATIONS

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Comparação das alterações hemodinâmicas na intoxicação aguda com bupivacaína e ropivacaína por via venosa em suínos

Comparison of hemodynamic changes in acute intoxication with intravenous bupivacaine and ropivacaine in swine

Marcos De Simone Melo; William Adalberto Silva; Ana Cristina de Moraes; Artur Udelsmann

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