Resuscitation strategies from bupivacaine-induced cardiac arrest.

OBJECTIVES: Local anesthetic (LA) intoxication with cardiovascular arrest is a potential fatal complication of regional anesthesia. Lipid resuscitation has been recommended for the treatment of LA-induced cardiac arrest. Aim of the study was to compare four different rescue regimens using epinephrine and/or lipid emulsion and vasopressin to treat cardiac arrest caused by bupivacaine intoxication. METHODS: Twenty-eight piglets were randomized into four groups (4 × 7), anesthetized with sevoflurane, intubated, and ventilated. Bupivacaine was infused with a syringe driver via central venous catheter at a rate of 1 mg·kg(-1)·min(-1) until circulatory arrest. Bupivacaine infusion and sevoflurane were then stopped, chest compression was started, and the pigs were ventilated with 100% oxygen. After 1 min, epinephrine 10 µg·kg(-1) (group 1), Intralipid(®) 20% 4 ml·kg(-1) (group 2), epinephrine 10 µg·kg(-1) + Intralipid(®) 4 ml·kg(-1) (group 3) or 2 IU vasopressin + Intralipid(®) 4 ml·kg(-1) (group 4) were administered. Secondary epinephrine doses were given after 5 min if required. RESULTS: Survival was 71%, 29%, 86%, and 57% in groups 1, 2, 3, and 4. Return of spontaneous circulation was regained only by initial administration of epinephrine alone or in combination with Intralipid(®). Piglets receiving the combination therapy survived without further epinephrine support. In contrast, in groups 2 and 4, return of spontaneous circulation was only achieved after secondary epinephrine rescue. CONCLUSIONS: In cardiac arrest caused by bupivacaine intoxication, first-line rescue with epinephrine and epinephrine + Intralipid(®) was more effective with regard to survival than Intralipid(®) alone and vasopressin + Intralipid(®) in this pig model.

Irregular tooth wear and longevity in captive wild ruminants: a pilot survey of necropsy reports.

Tooth wear is often suggested as an important factor limiting the life span of free-ranging wildlife. Given the frequent occurrence of poor dental health in captive animals reported in the literature, one would expect tooth health to be a limiting factor in captivity as well. Additionally, it could be assumed that brachydont (browsing) animals are more susceptible to dental health problems than are hypsodont (grazing) animals, given current indications for systematic increased tooth wear in some browsing species. A pilot survey of necropsy reports of adult captive wild ruminants (n = 294, 12 species) in one facility was performed in order to test these hypotheses and to calculate the incidence of irregular tooth wear. The overall incidence of irregular tooth wear was 20%, with a very high proportion of reports that did not mention the teeth at all. In contrast to this study's hypotheses, animals with irregular tooth wear were older than animals that died from other causes, indicating that reaching above-average age was a prerequisite for the development of reported abnormalities in this data set. A grazing species (blackbuck, Antilope cervicapra) was most affected, whereas two browsing species were not affected. Affected species had been regularly fed on sandy soil, whereas browsers had received feeds from racks, indicating that husbandry practices are most important for dental health. There was a high proportion of reported serous fat atrophy in animals with irregular tooth wear, indicating the clinical relevance of the problem. On average, adult individuals of the species investigated reached 41% of the maximum reported life span. Although this number appears low, the lack of comparative data from other facilities does not allow for conclusions on the adequacy of the husbandry practices used.