Absorption of lignocaine and bupivacaine from the respiratory tract during fibreoptic bronchoscopy.

McBurney, A; Jones, Daniel A.; Stanley, P.J.; Ward, JW

doi:10.1111/j.1365-2125.1984.tb05000.x

Cited by 12 publications

(7 citation statements)

References 12 publications

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“…Although no previous data exist on the extent of systemic absorption of bupivacaine when used for posttonsillectomy pain management, there are some insights regarding its application within the oral cavity and other parts of the respiratory tract. In an assessment of bupivacaine absorption during fiberoptic bronchoscopy, the average peak concentrations were 271 and 273 ng/mL after application via the upper and lower respiratory tract, respectively 17 . Another investigation, focusing on the absorption of bupivacaine after oropharyngeal spray application in dosages between 20 and 80 mg 18 revealed that even the 20 mg dose yielded a concentration around 150 ng/mL, that is, higher than our findings.…”

Section: Discussioncontrasting

confidence: 75%

“…In our study, peak concentration appeared, on average, 11 min postdrug application, which is faster than the 30-60 min reported in the aforementioned studies. [17][18][19] This suggests that our 4-min swab application of bupivacaine might have a reduced depot effect postremoval. Obviously, different formulations and application methods could lead to variations in absorption and concentration timelines.…”

Section: Mean ± Sd Min-maxmentioning

confidence: 99%

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Absorption and pharmacokinetics of bupivacaine after bilateral topical administration in tonsillar fossae for posttonsillectomy pain relief

Berg,

Seines,

Gál

et al. 2024

Pharmacology Res & Perspec

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No previous studies have investigated the systemic absorption of bupivacaine when used topically for posttonsillectomy pain. The present study was undertaken to investigate the pharmacokinetics of bupivacaine after administration by a swab in the tonsillar fossae over 4 min after tonsillectomy. Eleven adult patients undergoing elective tonsillectomy were recruited. After removal of both tonsils, each of the two tonsillar fossae was covered with a swab moistened with 2 mL of bupivacaine 5 mg/mL, that is, a total of 20 mg bupivacaine. Blood samples were drawn after 0, 5, 10, 20, 30, 45, and 60 min. Bupivacaine was analyzed with an ultra‐high‐performance liquid chromatography–tandem mass spectrometry method. The highest single measured bupivacaine serum concentration was 23.2 ng/mL and took place 10 min after drug administration. Mean (±SD) Cmax was 11.4 ± 6.0 ng/mL and mean tmax was 11.3 ± 4.7 min. Mean t1/2 was 31.6 ± 9.3 min. As the toxic concentration threshold has been reported to be in the interval 1500–4500 ng/mL, the concentrations measured were well below 2% of the lowest cited toxic threshold. In conclusion, this study shows that applying 4 mL of bupivacaine 5 mg/mL by a swab in the tonsillar fossae posttonsillectomy yields very low plasma concentrations, suggesting its safe application without any risk of systemic toxic effects.

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Section: Discussioncontrasting

confidence: 75%

Section: Mean ± Sd Min-maxmentioning

confidence: 99%

Absorption and pharmacokinetics of bupivacaine after bilateral topical administration in tonsillar fossae for posttonsillectomy pain relief

Berg,

Seines,

Gál

et al. 2024

Pharmacology Res & Perspec

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“…[6][7][8][9][10] Several clinical trials have examined lidocaine blood concentrations after topical anesthesia for bronchoscopy, finding nontoxic concentrations in all study subjects. [11][12][13][14][15][16] Other clinical trials, however, reported concentrations in the toxic range after similar application, suggesting a potential for t o~i c i t y .~~-~~ A decrease in lidocaine clearance was reported in elderly subjects. *' As a result, older patients undergoing bronchoscopy may be at greater risk for the development of elevated drug concentrations and signs and symptoms of toxicity after topical anesthesia.…”

mentioning

confidence: 99%

Systemic Absorption of Topical Lidocaine in Elderly and Young Adults Undergoing Bronchoscopy

1989

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This study compared the systemic absorption of topically administered lidocaine in elderly and young adult patients who were undergoing fiberoptic bronchoscopy. Fourteen elderly subjects aged 60-72 years (mean 67 years) and five young subjects age 31-48 years (mean 42 years) were compared with respect to dosage requirements to achieve satisfactory local anesthesia, rate and extent of lidocaine systemic absorption, plasma drug levels, elimination half-life, and drug side effects. Blood samples were drawn prior to, during, and for an average of 3 hours after the completion of bronchoscopy. Lidocaine plasma concentrations averaged in the range of 3.04-0.88 micrograms/ml from the beginning of the procedure to the end of blood sampling. Despite high cumulative amounts of 19 mg/kg (1200 mg) of lidocaine administered topically, the regimen proved relatively safe and achieved satisfactory anesthesia. In patients without known risk factors either for delayed hepatic lidocaine clearance or for enhanced mucosal absorption, the regimen is suitable for both young and old individuals.

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“…Aerosolized local anaesthetics are rapidly absorbed from the airways to yield substantial plasma concentrations [25,26]. The possibility exists, therefore, that the antitussive effect of lignocaine was due to an interaction of absorbed drug with peripheral or central nervous pathways in the cough reflex.…”

Section: Discussionmentioning

confidence: 99%

Separation of cough and reflex bronchoconstriction by inhaled local anaesthetics

Choudry

Fuller²,

Anderson³

et al. 1990

Eur Respir J

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Cough and airway constriction are common features of respiratory diseases. Both can be caused by stimulation of airway nerves. We have studied the effects of airway anaesthesia on these reflexes, stimulated by inhaled capsaicin, in order to determine whether they are controlled by the same sensory nerves. Ten volunteers had capsaicin cough dose responses performed before and at 10 min after inhaling placebo (ascorbic acid in saline), and the topical anaesthetics lignocaine 40 mg, and dyclonine 8 and 4 mg. The effect of the drugs on respiratory resistance (Rrs), measured using a forced oscillation technique, was measured both before and after the inhalation of a dose of capsaicin which caused less than two coughs. Lignocaine (40 mg) and dyclonine (8 mg) caused significant reports of oral anaesthesia but only lignocaine reduced the cough response to inhaled capsaicin, increasing the log dose of capsaicin causing three or more coughs by 162%. None of the treatments altered basal Rrs or its increase after inhaled capsaicin. Thus, the cough and reflex bronchoconstriction caused by inhaled capsaicin have different sensitivities to inhaled local anaesthesia, suggesting that the effect may be mediated by different sensory pathways.

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Absorption of lignocaine and bupivacaine from the respiratory tract during fibreoptic bronchoscopy.

Cited by 12 publications

References 12 publications

Absorption and pharmacokinetics of bupivacaine after bilateral topical administration in tonsillar fossae for posttonsillectomy pain relief

Absorption and pharmacokinetics of bupivacaine after bilateral topical administration in tonsillar fossae for posttonsillectomy pain relief

Systemic Absorption of Topical Lidocaine in Elderly and Young Adults Undergoing Bronchoscopy

Separation of cough and reflex bronchoconstriction by inhaled local anaesthetics

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