A novel role for lidocaine in COVID-19 patients?

Finnerty, Dylan; Buggy, Donal J.

doi:10.1016/j.bja.2020.07.015

Cited by 15 publications

(8 citation statements)

References 36 publications

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“…We therefore did not screen for COVID-19 tests, risk factors, or both in our patients. However, LAs as a co-medication in severe cases of ARDS seem to be a reasonable option [ 39 ]. Protection from lung damage by LAs has already been shown in animal models [ 14 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Anti-Inflammatory Characteristics of Local Anesthetics: Inhibition of TNF-α Secretion of Lipopolysaccharide-Stimulated Leucocytes in Human Blood Samples

Weinschenk

Weiss

Benrath

et al. 2022

IJMS

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Background. Local anesthetics (LAs) have potent anti-inflammatory properties. Inflammatory down-regulation is crucial in diseases with overactive immune reactions, such as acute respiratory distress syndrome (ARDS) and chronic inflammation. We investigated the influence of four LAs, procaine, lidocaine, mepivacaine, and bupivacaine, on the reduction of tumor necrosis factor-alpha (TNF-α) secretion in lipopolysaccharide (LPS)-activated human leucocytes. Methods. Blood samples of 28 individuals were stimulated with LPS. The reduction of TNF-α production by each of the four LAs added (0.5 mg/mL) was measured and correlated with biometric variables. A response was defined as reduction to <85% of initial levels. Results. All four LAs down-regulated the TNF-α secretion in 44–61%: Bupivacaine (44.4%), lidocaine (61.5%), mepivacaine (44.4%), and procaine (50% of the individuals, “responders”). The TNF-α secretion was reduced to 67.4, 68.0, 63.6, and 67.1% of the initial values in responders. The effects in both patients and healthy persons were the same. Interindividual responses to LAs were not correlated with the duration or type of complaints, basal TNF-α serum level, sex, BMI, or age of responders. Conclusions. Four clinically relevant LAs (amid-LA and ester-LA) attenuate the inflammatory response provoked by LPS. They are potential candidates for drug repositioning in treating overactive immune reactions and chronic inflammation.

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Section: Discussionmentioning

confidence: 99%

Anti-Inflammatory Characteristics of Local Anesthetics: Inhibition of TNF-α Secretion of Lipopolysaccharide-Stimulated Leucocytes in Human Blood Samples

Weinschenk

Weiss

Benrath

et al. 2022

IJMS

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“…[ 6 ] Finnerty hypothesized that lidocaine infusion in COVID-19 patients may decrease the formation of neutrophil extracellular traps and modulate the severity of disease, and recommended it as a potential therapy. [ 7 ] Anti-inflammatory properties of nebulized lidocaine[ 8 ] have also been suggested for COVID-19, however, many hospitals including ours do not favor aerosolized medications in COVID patients, and we chose the intravenous route.…”

Section: Discussionmentioning

confidence: 99%

Intravenous lidocaine infusion in a case of severe COVID-19 infection

Rylova

Chowdhury

Amirfarzan

et al. 2021

J Anaesthesiol Clin Pharmacol

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A subset of patients with COVID-19 develops a severe inflammatory response that may lead to respiratory and multiorgan failure. Effective treatment strategies to mitigate or interrupt this self-destructive inflammatory process are limited. The local anesthetic lidocaine has anti-inflammatory properties in addition to its analgesic, antiarrhythmic, and sedating effects that may be beneficial in critically ill COVID-19 patients. We report the case of a patient with COVID-19 induced severe respiratory distress who was intubated and received supportive treatment including proning and neuromuscular blockade. He developed a strong inflammatory response that we treated with an intermittent lidocaine infusion resulting in subsequent resolution. This case occurred prior to emerging data from a large dexamethasone use trial that demonstrated a survival benefit from its use in hospitalized COVID-19 patients. At the time, lidocaine was the only anti-inflammatory medication our patient received.

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“…The inhalation of heated helium–oxygen breathing mixture (He-70%, O 2 -30%) is carried out for 5–10 min, and then inhalation is performed using “Thermohelix-Pro” apparatus and Pari Velox mesh nebulizer [ 39 , 40 ] using 5 mL of 7.5% sodium thiosulfate solution 2–3 times a day. The course of treatment is 7–14 days.…”

Section: Methodsmentioning

confidence: 99%

The Effects of H2S and Recombinant Human Hsp70 on Inflammation Induced by SARS and Other Agents In Vitro and In Vivo

et al. 2022

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The ongoing epidemic caused by SARS-CoV-2 infection led to the search for fundamentally new ways and means to combat inflammation and other pathologies caused by this virus. Using a cellular model of lipopolysaccharide (LPS)-induced sepsis (human promonocytes), we showed that both a hydrogen sulfide donor (sodium thiosulfate, STS) and a recombinant Heat shock protein 70 (rHsp70) effectively block all major inflammatory mediators when administrated before and after LPS challenge. The protective anti-inflammatory effect of rHsp70 and H2S was also confirmed in vivo using various animal models of pneumonia. Specifically, it was found that rHsp70 injections prevented the development of the acute respiratory distress syndrome in highly pathogenic pneumonia in mice, increased animal survival, and reduced the number of Programmed death-1 (PD-1)-positive T-lymphocytes in peripheral blood. Based on our model experiments we developed a combined two-phase therapeutic approach for the treatment of COVID-19 patients. This procedure includes the inhalation of hot helium–oxygen mixtures for induction of endogenous Hsp70 in the first phase and STS inhalation in the second phase. The use of this approach has yielded positive results in COVID-19 patients, reducing the area of lung lesions, restoring parameters of innate immunity and T-cell immune response against coronavirus infection, and preventing the development of pulmonary fibrosis and immune exhaustion syndrome.

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A novel role for lidocaine in COVID-19 patients?

Cited by 15 publications

References 36 publications

Anti-Inflammatory Characteristics of Local Anesthetics: Inhibition of TNF-α Secretion of Lipopolysaccharide-Stimulated Leucocytes in Human Blood Samples

Anti-Inflammatory Characteristics of Local Anesthetics: Inhibition of TNF-α Secretion of Lipopolysaccharide-Stimulated Leucocytes in Human Blood Samples

Intravenous lidocaine infusion in a case of severe COVID-19 infection

The Effects of H2S and Recombinant Human Hsp70 on Inflammation Induced by SARS and Other Agents In Vitro and In Vivo

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