Ask Us > Measurement of bupivacaine level in blood after successful lipid rescue following LAST
Hi David,
In short, 'yes, yes and yes'. for the last question (no pun) the answer depends on the laboratories specific method of preparation. Typically howerver, only plasma is likely to have been sent to the outside lab and they are very unlikely to have processed it further (eg ultracentrifuging) to separate lipid-bound bupivacaine. So lets assume that the value was from total plasma. NOte, However, I think the reported concentration is quite reasonable since the acute toxicity reflects the concentration that washed (very temporarily) through the coronary circulation and not the plasma level equilibrated from all organs an hour later. That is, even a small amount of LA into the circulation can create enough of a spike in tissue (cardiac) concentration to trigger a severe, even fatal arrhythmia. anyway, important to know that you didn't have a huge intravascular injection. More important, allow me to encourage you to submit the actual case report!
Thanks,
Guy
In short, 'yes, yes and yes'. for the last question (no pun) the answer depends on the laboratories specific method of preparation. Typically howerver, only plasma is likely to have been sent to the outside lab and they are very unlikely to have processed it further (eg ultracentrifuging) to separate lipid-bound bupivacaine. So lets assume that the value was from total plasma. NOte, However, I think the reported concentration is quite reasonable since the acute toxicity reflects the concentration that washed (very temporarily) through the coronary circulation and not the plasma level equilibrated from all organs an hour later. That is, even a small amount of LA into the circulation can create enough of a spike in tissue (cardiac) concentration to trigger a severe, even fatal arrhythmia. anyway, important to know that you didn't have a huge intravascular injection. More important, allow me to encourage you to submit the actual case report!
Thanks,
Guy
March 13, 2014 |
[Guy Weinberg]
[Guy Weinberg]
Could the 1-hour delay from the LAST event to the venous blood collection have caused a lowering of the measured bupivacaine level? Could the 8-day delay from blood collection to assay have caused a lowering of the measured bupivacaine level?
Could the bupivacaine sequestered within the lipid phase of the blood have been "hidden" from this measurement, or does this measurement represent an aggregate of free plus protein-bound plus lipid-sequestered bupivacaine?