Enhancement by Hyponatremia and Hyperkalemia of Ventricular Conduction and Rhythm Disorders Caused by Bupivacaine

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Intraventricular conduction disorders and reentrant arrhythmias in dogs can be produced by high plasma bupivacaine concentrations. The authors' aim was to determine if these conduction disturbances also occurred at moderate plasma bupivacaine concentrations (2.2–3.7 μg/ml) when in association with other factors which affect in-tracardiac conduction, such as hyponatremia and hyperkalemia. Thus, duration of the QRS complex, ventricular conduction time, and effective refractory period (ERP) was measured during ventricular pacing at 180 beats per min in 46 anesthetized, closed-chest dogs separated into five treatment groups as follows: group I, an iv bolus of 4 mg/kg of bupivacaine plus an infusion of 0.1 mg-kg-1 · min-1 of bupivacaine followed in 50–60 min by 10 ml · kg-1 · min-1 of 1.5% glycine iv to produce dilutional hyponatremia; group II, 1.5% glycine alone, as above; group III, bupivacaine, as above, followed in 50–60 min by 0.05 mmol · kg-1 · min-1 of KC1 iv to produce hyperkalemia; group IV, KCl alone, as above; and group V, bupivacaine, as above, except that the duration of infusion was 90 min. QRS duration and ventricular conduction time, which were prolonged approximately 33% and 61%, respectively, by bupivacaine alone were additionally prolonged 29% and 44%, respectively, when serum sodium concentration was lowered to 114 mmol/ 1 and potassium concentration was raised to 7.7 mmol/1. The combinations of bupivacaine and hyponatremia, and bupivacaine and hyperkalemia tended to increase ERP more than did bupivacaine alone, although these changes were not statistically significant. Wave burst arrhythmias and episodes of ventricular tachycardia occurred spontaneously or were triggered by pacing in those dogs in which conduction time was most prolonged. The authors conclude that the effects of hyponatremia and hyperkalemia on cardiac conduction, when superimposed on the effects of moderate plasma concentrations of bupivacaine, may result in severe or even fatal cardiac arrhythmias in dogs.

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