Insulin effect on bupivacaine-induced cardiotoxicity in rabbits

BACKGROUND: Resuscitation following bupivacaine-induced cardiovascular collapse is difficult and often refractory to conventional treatment. This study was performed to assess the effect of insulin on bupivacaine-induced cardiovascular collapse in pentobarbital-anesthetized rabbits. METHODS: Bupivacaine was administered at 0.75 mg/kg/min until the heart rate decreased to 65 beats/min. A bolus of regular insulin (2 U/kg) was administered intravenously at the bupivacaine infusion endpoint (BIE) in the insulin group (n = 8), and 2 mL of 0.9% NaCl was administered to the control group (n = 8). RESULTS: All animals in the insulin group survived and four animals died in the control group. Arrythymia was rare 10 minutes after the BIE in the insulin group. CONCLUSIONS: Bupivacaine-induced cardiovascular collapse can be effectively reversed with an insulin injection, probably through facilitation of cardiac conduction and contraction.