The effects of an insulin-glucose-potassium (IGK) pretreatment on the bupivacaine cardiotoxicity

Kim, Jin-Tae; Yang, Sol-Mon; Kook Hyun Lee
January 2013
Korean Journal of Anesthesiology;Jan2013, Vol. 64 Issue 1, p47
Academic Journal
Background: The purpose of this study is to evaluate the effect of an IGK pretreatment on the cardiotoxicity of bupivacaine. Methods: Twenty-one anesthetized mongrel dogs were randomly divided into the following three groups: the control group (CG, n = 7), the treatment group (TG, n = 7) and the pretreatment group (PTG, n = 7). For the 30 min of pretreatment period, CG and TG received normal saline, while PTG received an IV bolus of insulin 2 U/kg, followed by an IGK infusion (2 U/kg/hr of insulin, 0.5-1.5 g/kg/hr of glucose, 1-2 mEq/kg/hr of KCl). The bupivacaine infusion was started at the rate of 0.5 mg/kg/min in all groups after the pretreatment period. CG received normal saline only. In TG, insulin (2 U/kg) was injected simultaneously with bupivacaine infusion, followed by the IGK infusion as with PTG. The hemodynamic variables and the time duration to reach the mean arterial pressure (MAP) of 60 mmHg were compared. Results: The bupivacaine infusion decreased the cardiac index, MAP, and heart rate in all three groups. Although insulin concentration was higher in TG than in PTG during bupivacaine infusion, the hemodynamic variables in PTG decreased at the slowest rate. The time taken to reach MAP of 60 mmHg in PTG, TG, and CG was 51.4 ± 8.5, 36.4 ± 9.6, and 27.1 ± 8.7 min, respectively (P < 0.05). Conclusions: IGK delays the bupivacaine-induced cardiac depression. However, a pretreatment with IGK is more effective in delaying the bupivacaine-induced hypotension than simultaneous administration, regardless of insulin concentration.


Related Articles

  • Pharmacology of anaesthetic agents I: intravenous anaesthetic agents. Khan, Khurram Saleem; Hayes, Ivan; Buggy, Donal J // Continuing Education in Anaesthesia, Critical Care & Pain;Jun2014, Vol. 14 Issue 3, p100 

    The article discusses the pharmacology and mechanism of action of anaesthetics agents. It mentions the effects of anesthetic agents on several organ systems including central nervous, cardiovascular and respiratory. It also presents brief overview of several drugs including propofol, thiopental...

  • Three Year Prospective Parallel Trial in 2 Groups of Patients with Type 2 Diabetes and Cardiovascular Disease and Utilization of Rosiglitazone. Lee, Scott Lee W.; Thorpe, Donna; Petrofsky, Jerrold; Cordoniz, Kevin; Cacho, Valerie; Hassen, Allen; Phatak, Sonal; Fermin, Roxanne; Salem, Nora; Morgan, Maha; Nayak, Kavita; Liokumovych, Victoria; Di Francisco, Miguel; George, Annie // Diabetes;Jun2007 Supplement 1, Vol. 56, pA550 

    Coronary artery disease (CAD) represents a major cause of morbidity and mortality in patients with type 2 diabetes. The insulin sensitizer and peroxisome proliferator-activated receptor γ(PPARγ) ligand rosiglitazone (RSG) has been shown to improve endothelial function in preclinical and...

  • An Analysis of Drug Findings in Drug-Facilitated Sexual Assault Cases. Jackson, George F.; Dunn, William A. // Journal of Analytical Toxicology;Apr2003, Vol. 27 Issue 3, p179 

    Presents an analysis of drug-facilitated sexual assault (DFSA) cases submitted to the U.S. National Medical Services in the time period of January 2000 through March 2002. Benefits of this analysis; Overview of specimen types submitted for this analysis; Highlights of various drugs found to be...

  • The Effect of Novel Promoter Variants in MATE1 and MATE2 on the Pharmacokinetics and Pharmacodynamics of Metformin. Stocker, S L; Morrissey, K M; Yee, S W; Castro, R A; Xu, L; Dahlin, A; Ramirez, A H; Roden, D M; Wilke, R A; McCarty, C A; Davis, R L; Brett, C M; Giacomini, K M // Clinical Pharmacology & Therapeutics;Feb2013, Vol. 93 Issue 2, p186 

    Interindividual variation in response to metformin, first-line therapy for type 2 diabetes, is substantial. Given that transporters are determinants of metformin pharmacokinetics, we examined the effects of promoter variants in both multidrug and toxin extrusion protein 1 (MATE1)...

  • Percutaneous Penetration of Local Anesthetic Bases: Pharmacodynamic Measurements. Leopold, Claudia S.; Maibach, Howard I. // Journal of Investigative Dermatology;Sep99, Vol. 113 Issue 3, p304 

    Local anesthetics do not penetrate readily through human skin if applied in their salt form; however, if applied in their base form various effects may be observed, such as a decrease in pricking pain and a change in burning, itch, and thermal sensations. These effects occur after skin...

  • Authors' Reply to Anoop Balachandran et al.: Comment on 'Sub-Anesthetic Xenon Increases Erythropoietin Levels in Humans: A Randomized Controlled Trial'. Stoppe, Christian; Ney, Julia; Rossaint, Rolf; Coburn, Mark; Goetzenich, Andreas // Sports Medicine;Feb2017, Vol. 47 Issue 2, p381 

    A response from the author of the article "Sub-Anesthetic Xenon Increases Erythropoietin Levels in Humans: A Randomized Controlled Trial" in the 2016 issue is presented.

  • Comment on 'Sub-anesthetic Xenon Increases Erythropoietin Levels in Humans: A Randomized Controlled Trial'. Balachandran, Anoop; Streiner, David; Signorile, Joseph // Sports Medicine;Feb2017, Vol. 47 Issue 2, p379 

    A letter to the editor is presented in response to the article "Sub-Anesthetic Xenon Increases Erythropoietin Levels in Humans: A Randomized Controlled Trial" by Christina Stoppe and colleagues in the 2016 issue.

  • Beta-blockers in the Perioperative Period: Are there Indications other than Prevention of Cardiac Ischemia? Kadoi, Y.; Saito, S. // Current Drug Targets;Sep2009, Vol. 10 Issue 9, p842 

    Beta-blocker therapy is accepted to reduce perioperative cardiovascular complications. Moreover, betablockers have potentially beneficial effects other than prevention of cardiac events. In addition to reducing anesthetic and analgesic requirements during the perioperative period, beta-blockers...

  • Is there a link between malignant hyperthermia and exertional heat illness? Hopkins, P. M. // British Journal of Sports Medicine;May2007, Vol. 41 Issue 5, p283 

    The article investigates the association between malignant hyperthermia (MH) and exertional heat illness. MH is an uncommon pharmacogenetic disorder inherited in an autosomal dominant fashion which is triggered in previously healthy susceptible individuals by exposure to potent inhalational...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics