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Insulin effects on myocardial function and bioenergetics in l-bupivacaine toxicity in the isolated rat heart

Published online by Cambridge University Press:  01 April 2007

S. N. Stehr
Affiliation:
Medical Faculty Carl Gustav Carus, Department of Anaesthesiology and Intensive Care Medicine
A. Pexa
Affiliation:
Institute of Physiology, Dresden, Germany
S. Hannack
Affiliation:
Medical Faculty Carl Gustav Carus, Department of Anaesthesiology and Intensive Care Medicine
A. Heintz
Affiliation:
Medical Faculty Carl Gustav Carus, Department of Anaesthesiology and Intensive Care Medicine
A. R. Heller
Affiliation:
Medical Faculty Carl Gustav Carus, Department of Anaesthesiology and Intensive Care Medicine
A. Deussen
Affiliation:
Institute of Physiology, Dresden, Germany
T. Koch
Affiliation:
Medical Faculty Carl Gustav Carus, Department of Anaesthesiology and Intensive Care Medicine
M. Hübler
Affiliation:
Medical Faculty Carl Gustav Carus, Department of Anaesthesiology and Intensive Care Medicine
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Summary

Background and objectives

A positive effect of insulin–glucose–potassium infusion in severe bupivacaine-induced cardiovascular collapse has been described in vivo. It has been speculated that an antagonistic influence of insulin on sodium channel inhibition, transient outward potassium current, calcium-dependent adenosine triphosphatase or even improved myocardial energetics may be responsible for this effect. Using an isolated heart model, we therefore sought to further elucidate insulin effects in l-bupivacaine-induced myocardial depression.

Methods

An isolated rat heart constant-pressure perfused, non-recirculating Langendorff preparation was used. Hearts were exposed to l-bupivacaine 5 μg mL−1 and insulin 10 mIU mL−1. Heart rate, systolic pressure, the first derivative of left ventricular pressure (+dP/dt), coronary flow, double product, PR and QRS intervals were recorded. Hearts were freeze-clamped and high-performance liquid chromatography measurement of the total adenine nucleotide pool was performed.

Results

l-Bupivacaine led to a significant decrease in heart rate, +dP/dt, systolic pressure, coronary flow and double product, and to an increase in PR and QRS. Insulin exerted a positive inotropic effect, significantly augmenting +dP/dt and systolic pressure in both l-bupivacaine-treated and control hearts. Heart rate, coronary flow, total adenine nucleotides, PR and QRS were not significantly changed by the insulin intervention.

Conclusion

Insulin did not have a significant effect on total adenine nucleotides in controls and in l-bupivacaine-treated hearts. However, it does exert a positive inotropic action in bupivacaine-induced myocardial depression. We conclude that the positive effect of insulin application lies in positive inotropic action and not in changes in total adenine nucleotides.

Type
Research Article
Copyright
Copyright © European Society of Anaesthesiology 2007

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