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Fig. 1
Flowchart of the experimental protocol with 13 distinct points 1: Baseline, 2: 5΄ Amiodarone infusion; 3: 10΄ Amiodarone infusion; 4: 15΄ Amiodarone infusion; 5: 20 Amiodarone infusion; 6: 2΄ Bolus infusion 7: 15΄ infusion; 8: 30΄ infusion; 9: 45΄ infusion; 10: 1 hour monitoring; 11: 2 hours monitoring; 12: 3 hours monitoring; 13: 4 hours monitoring.
Fig. 2
Systolic aortic pressure versus time. The asterix indicates statistical significant difference between the two groups.
1: Baseline, 2: 5΄ Amiodarone infusion; 3: 10΄ Amiodarone infusion; 4: 15΄ Amiodarone infusion; 5: 20 Amiodarone infusion; 6: 2΄ Bolus infusion 7: 15΄ infusion; 8: 30΄ infusion; 9: 45΄ infusion; 10: 1 hour monitoring; 11: 2 hours monitoring; 12: 3 hours monitoring; 13: 4 hours monitoring.
Abstract
Purpose
To investigate whether a lipid emulsion could counteract the hypotensive effects of amiodarone overdose after an acute intravenous administration and improve 4h survival in an established model of swine cardiovascular research.
Methods
Twenty pigs were intubated and instrumented to measure aortic pressures, central venous pressures (CVP). After allowing the animals to stabilize for 60 minutes, amiodarone overdose (1 mg/kg/min) was initiated for a maximum of 20 minutes. Afterwards, the animals were randomized into 2 groups. Group A (n=10) received 0.9% Normal Saline (NS) and Group B (n=10) received 20% Intralipid® (ILE). A bolus dose of 2 ml/kg in over 2 min time was initially administered in both groups followed by a 45min infusion (0.2 ml/kg/min) of either NS or ILE.
Results
All animals survived the overdose and all animals survived the monitoring period of 4 hours. Systolic aortic pressure (6.90 vs 14.10mmHg, p=0.006) and MAP (6.10 vs 14.90mmHg, p=0.001) were higher in the ILE group 2 min after the bolus ILE infusion. This difference was maintained for 15 min after ILE infusion for both SpthAorta (7.85 vs 13.15mmHg, p=0.044) and MAP (7.85 vs 13.15mmHg, p=0.042). Animals that received ILE had higher central venous pressure (11.6 vs 15.7 mmHg, p=0.046), an effect which was attenuated 2 and 4 hours post administration. Animals receiving ILE were more acidotic (7.21 vs 7.38, p=0.048) in the monitoring period compared to animals receiving NS.
Conclusions
Intralipid attenuated the hypotensive effects of amiodarone toxicity for a period of 15 minutes compared to animals receiving NS.
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Source(s) of support: Experimental - Research Center ELPEN Pharmaceuticals (E.R.C.E.). Keywords: lipid emulsion; amiodarone overdose; survival
Conflicts of interest: The authors report no relationships that could be construed as a conflict of interest.
