Terapia lipídica com dois agentes na intoxicação por ropivacaína: estudo experimental em suínos

Matheus Rodrigues Bonfim; Marcos De Simone Melo; Elisabeth Dreyer; Luís Fernando Affini Borsoi; Thales Gê de Oliveira; Artur Udelsmann

doi:10.1590/S0034-70942012000500008

Scientific Article

Terapia lipídica com dois agentes na intoxicação por ropivacaína: estudo experimental em suínos

Lipid therapy with two agents in ropivacaine-induced toxicity: experimental study in swine

Matheus Rodrigues Bonfim; Marcos De Simone Melo; Elisabeth Dreyer; Luís Fernando Affini Borsoi; Thales Gê de Oliveira; Artur Udelsmann

http://dx.doi.org/10.1590/S0034-70942012000500008 Braz J Anesthesiol, vol.62, n5, p.690-695, 2012

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OBJETIVO: Comparar alterações hemodinâmicas após intoxicação com ropivacaína seguida de terapia com duas emulsões lipídicas em suínos. MÉTODO: Suínos da raça Large White foram anestesiados com tiopental, intubados e mantidos em ventilação mecânica. Variáveis hemodinâmicas de repouso foram registradas através de pressão invasiva e cateterização da artéria pulmonar. Após 30 minutos, 7 mg.kg-1 de ropivacaína foram injetados por via venosa e novas medidas hemodinâmicas foram feitas em um minuto; os animais foram então aleatoriamente alocados em três grupos e receberam: 4 mL.kg-1 de solução salina, 4 mL.kg-1 de solução lipídica com triglicérides de cadeia longa e 4 mL.kg-1 de solução lipídica com triglicérides de cadeia média e longa. As alterações hemodinâmicas foram reavaliadas aos cinco, 10, 15, 20 e 30 minutos. RESULTADOS: A intoxicação pela ropivacaína causou queda da pressão arterial e do índice cardíaco, principalmente, sem importantes alterações das resistências vasculares. A terapia com as emulsões lipídicas restaurou a pressão arterial através, principalmente, do aumento das resistências vasculares, uma vez que o índice cardíaco não apresentou melhoria expressiva. A emulsão lipídica com triglicérides de cadeia média causou aumento superior das resistências vasculares, sobretudo pulmonares. CONCLUSÃO: Nos grupos que receberam emulsões lipídicas os resultados hemodinâmicos foram melhores do que no grupo controle; não foram observadas diferenças da pressão arterial sistêmica e do índice cardíaco entre os animais que receberam a solução com triglicérides de cadeia longa e a mistura de triglicérides de cadeia média e longa.

Palavras-chave

ANESTÉSICOS, Local, ropivacaína, ANIMAL, Porco, COMPLICAÇÕES, Injeção acidental, Emulsões Gordurosas Intravenosas

Abstract

BACKGROUND AND OBJECTIVE: Compare hemodynamic changes after ropivacaine-induced toxicity followed by treatment with two lipid emulsions in swine. METHODS: Large White pigs were anesthetized with thiopental, followed by intubation, and kept on mechanical ventilation. Hemodynamic variables at rest were recorded with invasive pressure monitoring and pulmonary artery catheterization. After 30 minutes, 7 mg.kg-1 ropivacaine were injected intravenously and new hemodynamic measurements were performed within one minute. The animals were then randomly allocated into three groups and received: 4 mL.kg-1 saline solution, or 4 mL.kg-1 lipid emulsion with long-chain triglycerides, or 4 mL.kg-1 lipid emulsion with long-and medium-chain triglycerides. Hemodynamic changes were reevaluated at 5, 10, 15, 20 and 30 minutes. RESULTS: Ropivacaine-induced toxicity mainly caused a drop in blood pressure and cardiac index without significant changes in vascular resistance. Therapy with lipid emulsions restored blood pressure primarily through increased vascular resistance, as cardiac index showed no significant improvement. Lipid emulsion with medium-chain triglycerides caused a greater increase in vascular resistance, particularly pulmonary. CONCLUSION: In groups receiving lipid emulsions, hemodynamic results were better than in control group. There were no differences in systemic arterial pressure and cardiac index between animals receiving lipid emulsion with long-chain triglycerides and mixed long- and medium-chain triglycerides.

Keywords

Anesthetics, Local, Accidents, Fat Emulsions, Intravenous, Swine

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Terapia lipídica com dois agentes na intoxicação por ropivacaína: estudo experimental em suínos

Lipid therapy with two agents in ropivacaine-induced toxicity: experimental study in swine

Matheus Rodrigues Bonfim; Marcos De Simone Melo; Elisabeth Dreyer; Luís Fernando Affini Borsoi; Thales Gê de Oliveira; Artur Udelsmann

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