Ask Us > Regarding Zausig paper: Bupi vs Ropi vs Mepi

I read with great interest the Zausig, et al. recent paper in A&A regarding LE recovery of Bupi Induced CA, but not Ropi or Mepi. This is in contrast to clinical reports. Furthermore, their studies lack of effect on return of spontaneous rhythm contradicts Dr. Weinberg's earlier studies. They theorize that the lipid sink effect only seems to be relevant in bupivacaine induced cardiac toxicity.

Interestingly, Zausig's study protocol included Medialipid/Lipofundin and not Intralipid. Could the lack of demonstrated recovery of Ropi and Mepi induced cardiac arrest be explained by the differences in the lipid emulsions? Mazoit, et al (Anesth 2009;110:380-6.) demonstrated a significant difference in the binding of Bupi (L-Bupi) and Ropiv to Intralipid compared to Medialipide, suggesting that Intralipid may be clinically superior to other lipid emulsion formulations.

Thoughts?
October 12, 2009 | Unregistered CommenterL Warren MD
Thank you so much for the cogent and thoughtful comments. I will respond in greater depth after I've had a chance to read the article carefully. My main concern at this point is the misleading title: not one in a thousand doctors think of a langendorff prep when reading about 'cardiac arrest'. In addition to the difference in formulations' potential efficacy, I think isolated heart vs intact animal/patient is a very big gap and we have to be very careful in making projections from one to the other. Right now, I'm busy preparing for ASA, but when I get back perhaps we should co-author a letter to tthe editor to cover all these relevant points.
Interested?
Guy
October 13, 2009 | Registered Commenter[Guy Weinberg]
I'd be very interested in co-authoring a letter regarding this issue, and look forward to hearing from you after the ASA.
Lisa
October 15, 2009 | Unregistered CommenterLisa Warren