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Correspondence |
Seoul, Korea
We thank Freysz et al. for their comments. Though there is a some similarity in the experimental design between the two studies,1,2 we think the point of the articles is different.
In our article,1 we intended to show that continuous mixed venous oxygen saturation correlated well with cardiac output in the early and late phases of bupivacaine intoxication. Mean blood pressure (MBP) was maintained in the early phase of bupivacaine-induced cardiotoxicity. MBP decreased abruptly and correlated well with cardiac output (CO) with impending cardiovascular collapse or at the late period of bupivacaine-induced cardiotoxicity.
The article by Beal et al.2 showed the changes of hemodynamics (CO decreased and mean systolic blood pressure remained unchanged) in the early period of bupivacaine (cardiac) intoxication. The concept of early and late bupivacaine cardiotoxicity is based on the results of Cho et al.3 and its definition can be found in our article.1 An earlier study showed that a plasma bupivacaine concentration of 1 to 2 µg•mL-1 increased BP and decreased CO.4 CO does not always decrease with bupivacaine administration. After convulsive doses (1 mg•kg-1), CO increases.5 In addition, the bupivacaine concentration in our study was much higher than in Beal et al.’s. We appreciate Drs. Freysz and Lenfant’s comments but, in our view, both studies were quite different.
References
1 Kim JT, Rhee KY, Bahk JH, et al. Continuous mixed venous oxygen saturation, not mean blood pressure, is associated with early bupivacaine cardiotoxicity in dogs. Can J Anesth 2003; 50: 376–81.
2 Beal JL, Freysz M, Timour Q, Bertrix L, Lang J, Faucon G. Haemodynamic effects of high plasma concentrations of bupivacaine in the dog. Eur J Anaesthesiol 1988; 5: 251–60.[Medline]
3 Cho HS, Lee JJ, Chung IS, Shin BS, Kim JA, Lee KH. Insulin reverses bupivacaine-induced cardiac depression in dogs. Anesth Analg 2000; 91: 1096–102.
4 Hasselstrom LJ, Mogensen T, Kehlet H, Christensen NJ. Effects of intravenous bupivacaine on cardiovascular function and plasma catecholamine levels in humans. Anesth Analg 1984; 63: 1053–8.
5 Rutten AJ, Nancarrow C, Mather LE, Ilsley AH, Runciman WB, Upton RN. Hemodynamic and central nervous system effects of intravenous bolus doses of lidocaine, bupivacaine, and ropivacaine in sheep. Anesth Analg 1989; 69: 291–9.
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