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Local anesthetic toxicity and milrinone

Lubbock, Texas

To the Editor:

I read with interest the article by Neustein et al.¹ entitled: "Milrinone is superior to epinephrine as treatment of myocardial depression due to ropivacaine in pigs". It is unfortunate that a vehicle control was not incorporated into the study design. Perhaps no treatment would have been better or as good as treatment with milrinone. My experience with studying local anesthetic toxicity in animal models is that if local anesthetic administration is stopped and vehicle treated animals are given oxygen with respiratory support they generally do recover unless asystole or ventricular fibrillation is induced. Even then, vehicle treated animals usually recover unless asystole is prolonged. I raise this issue because I subscribe to the old axiom that when one is in a hole and wants out, one should first stop digging. In other words, do not give more drugs if you are in trouble with one drug unless it is absolutely necessary.

Reference

1 Neustein S, Samson I, Dimich I, Shiang H, Tatu J. Milrinone is superior to epinephrine as treatment of myocardial depression due to ropivacaine in pigs. Can J Anesth 2000; 47: 1114–8.[Abstract]

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