Hemodynamic changes with two lipid emulsions for treatment of bupivacaine toxicity in swines

PURPOSE: To compare the hemodynamic changes following two different lipid emulsion therapies after bupivacaine intoxication in swines. METHODS: Large White pigs were anesthetized with thiopental, tracheal intubation performed and mechanical ventilation instituted. Hemodynamic variables were recorded with invasive pressure monitoring and pulmonary artery catheterization (Swan-Ganz catheter). After a 30-minute resting period, 5 mg.kg-1 of bupivacaine by intravenous injection was administered and new hemodynamic measures were performed 1 minute later; the animals were than randomly divided into three groups and received 4 ml.kg-1 of one of the two different lipid emulsion with standard long-chaim triglyceride, or mixture of long and medium-chain triglyceride, or saline solution. Hemodynamic changes were then re-evaluated at 5, 10, 15, 20 and 30 minutes. RESULTS: Bupivacaine intoxication caused fall in arterial blood pressure, cardiac index, ventricular systolic work index mainly and no important changes in vascular resistances. Both emulsion improved arterial blood pressure mainly increasing vascular resistance since the cardiac index had no significant improvement. On the systemic circulation the hemodynamic results were similar with both lipid emulsions. CONCLUSION: Both lipid emulsions were efficient and similar options to reverse hypotension in cases of bupivacaine toxicity.To compare the hemodynamic changes following two different lipid emulsion therapies after bupivacaine intoxication in swines. Large White pigs were anesthetized with thiopental, tracheal intubation performed and mechanical ventilation instituted. Hemodyna3028793sem informaçãosem informaçã

Hemodynamic effects of local anesthetics intoxication. Experimental study in swine with levobupivacaine and bupivacaine

Purpose: To compare the hemodynamic repercussions following a toxic dose of levobupivacaine and bupivacaine intravascularly injected in swines. Methods: Large White pigs were anesthetized with thiopental, tracheal intubation was performed and mechanical ventilation was instituted. Hemodynamic variables were recorded with invasive pressure monitoring and pulmonary artery catheterization (Swan-Ganz catheter). After a 30-minute resting period, the animals were randomly divided into two groups in a double-blinded fashion and received a bolus injection of 4 mg/kg of either agent for intoxication. Hemodynamic results were then evaluated at 1, 5, 10, 15, 20 and 30 minutes. Results: Levobupivacaine had greater hemodynamic repercussions than racemic bupivacaine. These results disagree with those found when the levorotatory isomer of bupivacaine was used in humans, but are in agreement with recently reported findings in animals. Conclusion: Levobupivacaine was shown to be more toxic in pigs than racemic bupivacaine when large doses are injected intravenously.231556

Forging volumetric methods

The last two decades have seen a “volumetric turn” within Anglophone social sciences and humanities scholarship. This turn is premised on the idea that space may be better understood in three-dimensional terms – with complex heights and depths – rather than as a series of two-dimensional areas or surfaces. While there is an increasingly diverse and rich set of scholarship accounting for voluminous complexities in the air, oceans, ice, mountains, and undergrounds, all too often this work foregrounds state and military-led approaches to volume. This has resulted in a limited methodological toolkit through which to explore voluminous complexities as they emerge and extend beyond military and state contexts. Often reliant on elite interviews, archives, and cartographies, there has been little critical discussion of both methodological practice and the “flatness” of research outputs articulating three-dimensional worlds. In this paper we address this by foregrounding the role of immersive and multisensory methodologies (sounding volumes, seeing-sensing drone volumes, and object volumes). To conclude, we offer avenues for further inquiry, including attending to shifting everyday voluminous experiences in the Anthropocene, and the need to diversify the communication of “volume” research

Civil, Criminal And Ethical Liability Of Medical Doctors [responsabilidade Civil, Penal E Etica Dos Médicos.]

In the last years doctors have been the target of a growing number of civil, criminal law suits, as well as ethical procedures. Medicine is a widely targeted career, not only owing to its inherent risks, but also owing to a mistaken approach of the Judiciary Power about the obligations of medical doctors. Decisions of the Medical Board in ethical procedures have an impact in civil and criminal justice and therefore should be followed closely. The purpose of this review is to provide a wide view from a doctor-lawyer perspective of cases involving civil, criminal liability of anesthesiologists as well as ethical procedures against them, in an effort to make them comprehensible to doctors.After a brief historical introduction civil liability foundations and legal articles are examined. Responsibilities of doctors, hospitals and health insurance providers are discussed separately, as well as reparation mechanisms. Crimes possible to occur during medical practice and respective penalties are described; the direct relationship between crime and civil reparation is demonstrated. The administrative nature of ethical procedure is described, emphasizing that the legal character of its penalties often serve as grounds for civil and criminal justice decisions.Prevention is still the best medicine. Good medical practice and a good medical-patient relationship are still the best ways to minimize lawsuits and their repercussions. Doctors should have some knowledge of juridical mechanisms in lawsuits and ethical procedures, but should not take defense initiatives without prior consultation of an attorney. Civil, criminal and ethical liability of physicians.48217218

Reply [2] [réplica]

[No abstract available]566682683Torres, M.L.A., Toxicidade dos anestésicos locais: O debate continua (2006) Rev Bras Anestesiol, 56, pp. 339-342Gonçalves, R.F., Lauretti, G.R., Mattos, A.L., Estudo comparativo entre bupivacaína a 0,5% e mistura enantiomérica de bupivacaína (S75-R25) a 0,5% em anestesia peridural (2003) Rev Bras Anestesiol, 53, pp. 169-176Masuda, R., Takeda, S., Yoshii, S., Levobupivacaine exerts the most detrimental effect on the cardiovascular system among enantiomers of bupivacaine in anesthetized dogs (2004) Anesthesiology, 101 (SUPPL.), pp. A652Jung, C.W., Lee, K.H., Choe, Y.S., Comparison of resuscitative effect of insulin between bupivacaine and levobupivacaine induced cardiovascular collapse in dogs (2004) Anesthesiology, 101 (SUPPL.), pp. A64