Adding Bupivacaine to High-potassium Cardioplegia Improves Function and Reduces Cellular Damage of Rat Isolated Hearts after Prolonged, Cold Storage

Background: Bupivacaine retards myocardial acidosis during ischemia. The authors measured function of rat isolated hearts after prolonged storage to determine whether bupivacaine improves cardiac protection compared with standard cardioplegia alone.

Methods: After measuring cardiac function on a Langendorff apparatus, hearts were perfused with cardioplegia alone (controls), cardioplegia containing 500 [mu]m bupivacaine, or cardioplegia containing 2 mm lidocaine; were stored at 4[degrees]C for 12 h; and were then reperfused. Heart rate and left ventricular developed pressures were measured for 60 min. Maximum positive rate of change in ventricular pressure, oxygen consumption, and lactate dehydrogenase release were also measured.

Results: All bupivacaine-treated, four of five lidocaine-treated, and no control hearts beat throughout the 60-min recovery period. Mean values of heart rate, left ventricular developed pressure, maximum positive rate of change in ventricular pressure, rate-pressure product, and efficiency in bupivacaine-treated hearts exceeded those of the control group (P < 0.001 at 60 min for all). Mean values of the lidocaine group were intermediate. Oxygen consumption of the control group exceeded the other groups early in recovery, but not at later times. Lactate dehydrogenase release from the bupivacaine group was less than that from the control group (P < 0.001) but did not differ from baseline.     

Chemical warfare agents

The first 150 words of the full text of this article appear below. Key points

• Chemical personal protective equipment must be wornwhen in contact with contaminated casualties.
• Recognizing theclinical features of chemical warfare agent poisoning allowssupportive treatment and appropriate antidotes to be promptlyadministered.
• The mnemonic DUMBELS describes the muscarinicfeatures of the nerve agent poisoning toxidrome.
• There areeffective antidotes for poisoning with nerve agents, blood agents(metabolic poisons), botulinum toxin and kolokol-1.
• There areno specific antidotes for blistering agents (vesicants) andchoking agents.

  Chemical warfare (CW) agents are chemical substances that havea direct toxic effect on plants, animals and humans. Classifiedaccording to their physiological effects, agents effective againsthumans include nerve agents, blistering agents (vesicants),blood agents, choking agents and toxins. Incapacitating, vomiting,psychoactive and riot control agents (e.g. CS gas) also exist.¹ All personnel in contact with contaminated casualties must wearthe appropriate level of chemical personal protective equipment(CPPE) until adequate decontamination is . . . [Full Text of this Article]