Effects of intramuscular administration of lidocaine or bupivacaine on induction and maintenance doses of propofol evaluated by bispectral index

Şentürk, Mert; Pembeci, Kamil; Menda, Ferdi; Özkan, Türker; Güçyetmez, Bülent; Tuğrul, Mehmet; Çamcı, Emre; Akpir, K.

doi:10.1093/bja/aef287

Cited by 51 publications

(40 citation statements)

References 12 publications

(7 reference statements)

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“…lidocaine infusion has a minimal alveolar concentration (MAC)-sparing effect of 10%~28%. In a later study (Senturk et al, 2002), an i.v. anesthetic was used instead of inhalational anesthetics, and lidocaine was administered via the i.m.…”

Section: Discussionmentioning

confidence: 94%

Comparison of 1.5% lidocaine and 0.5% ropivacaine epidural anesthesia combined with propofol general anesthesia guided by bispectral index

Xiang

2007

J. Zhejiang Univ. - Sci. B

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Abstract:Objective: To compare the effects of epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine on propofol requirements, the time to loss of consciousness (LOC), effect-site propofol concentrations, and the hemodynamic variables during induction of general anesthesia guided by bispectral index (BIS) were studied. Methods: Forty-five patients were divided into three groups to receive epidurally administered saline (Group S), 1.5% (w/w) lidocaine (Group L), or 0.5% (w/w) ropivacaine (Group R). Propofol infusion was started to produce blood concentration of 4 µg/ml. Once the BIS value reached 40~50, endotracheal intubation was facilitated by 0.1 mg/kg vecuronium. Measurements included the time to LOC, effect-site propofol concentrations, total propofol dose, mean arterial blood pressure (MABP), and heart rate (HR) at different study time points. Results: During induction of anesthesia, both Groups L and R were similar for the time to LOC, effect-site propofol concentrations, total propofol dose, MABP, HR, and BIS. The total doses of propofol administered until 1 min post-intubation were significantly less in patients of Groups R and L compared with Group S. MABP and HR were significantly lower following propofol induction compared with baseline values in the three groups, or MABP was significantly increased following intubation as compared with that prior to intubation in Group S but not in Groups R and L while HR was significantly increased following intubation in the three groups. Conclusion: Epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine has similar effects on the time to LOC, effect-site propofol concentrations, total propofol dose, and the hemodynamic variables during induction of general anesthesia.

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Section: Discussionmentioning

confidence: 94%

Comparison of 1.5% lidocaine and 0.5% ropivacaine epidural anesthesia combined with propofol general anesthesia guided by bispectral index

Xiang

2007

J. Zhejiang Univ. - Sci. B

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“…However, in ponies the reduction can reach up to 70% of halothane on MAC (DOHERTy; FRAZIER, 1998). Senturky et al (2002) observed that a single dose of lidocaine by intramuscular injection in humans was sufficient to reduce the necessary dose of propofol to maintain anesthesia by 29%. Mannarino (2002) found that applying 2.5 mg/kg followed by the infusion of 250 μg/kg/minute resulted in a reduction of 21% in the required propofol dose in dogs.…”

Section: Discussionmentioning

confidence: 99%

High doses of lidocaine as a constant rate infusion in propofol/fentanyl anaesthetized sheep: cardiorespiratory effects

et al. 2013

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The aim of this study was to investigate the cardiorespiratory and anesthetic-sparing effects of a highdose CRI of lidocaine (200 μg/kg/min) administered with a propofol/fentanyl regimen to sheep. Twelve adult, castrated male sheep (BW= 32.1 ± 4.9 kg), were used in a prospective, randomized clinical trial. All animals were premedicated with xylazine (0.05 mg/kg, i.m.). Animals in the GPF group were induced with propofol (3 mg/kg) and fentanyl (2.5 μg/kg) intravenously, and anesthesia was maintained with a CRI of propofol (500 μg/kg/min) and fentanyl (0.15 μg/kg/min). In the GPFL group, animals were induced with propofol (3 mg/kg), fentanyl (2.5 μg/kg) and lidocaine (2.5 mg/kg) intravenously, and anesthesia was maintained with a CRI of propofol (500 μg/kg/min), fentanyl (0.15 μg/kg/min) and lidocaine (200 μg/kg/min); after ten minutes of anesthesia, the propofol dose was reduced by 25% (from 500 μg/kg/min to 375 μg/kg/min). Cardiorespiratory parameters were recorded from 15 minutes after preanesthetic medication administration (T0) to the end of the anesthetic procedure (T7). The time points were as follows: T0 -15 minutes after preanesthetic medication administration; T1 -after anesthesia induction and orotracheal intubation; T2 -15 minutes of anesthesia; T3 -during traction on the liver; T4 -during bowel clamping; T5 -during muscle suture; T6 -at the end of skin suture; and T7 -15 minutes after the end of anesthesia. Apnea was present in all animals during anesthesia induction and required mechanical ventilation. There was no statistical difference in HR and MAP between any time points compared to the baseline value (p > 0.05); MAP was lower in the GPF group (p < 0.05) at time T6. In conclusion, this dose of lidocaine was sufficient to reduce the propofol requirement by 25%. A high-dose CRI of lidocaine in combination with a propofol/fentanyl regmine did not promote significant cardiovascular changes and was effective in reducing the propofol dose by 25%. ResumoO objetivo desse estudo foi investigar os efeitos cardiorrespiratórios e a redução na dose de propofol, mediante a infusão contínua de altas doses de lidocaína (200 μg/kg/min) em associação ao propofol/ fentanil. Para tanto, foram utilizados 12 ovinos machos castrados (peso médio de 32,1 ± 4,9 kg), distribuídos em dois grupos de seis animais, designados como grupo GPF e GPFL em estudo clínico, prospectivo e aleatório. Todos os animais foram pré-medicados com xilazina (0,05 mg/kg, i.m.). A indução anestésica do grupo GPF constou de propofol (3 mg/kg) e fentanil (2,5 μg/kg) adminitrados por via intravenosa e a anestesia foi mantida com a infusão contínua de propofol (500 μg/kg/min) e fentanil (0,15 μg/kg/min). No grupo GPFL foram induzidos a anestesia com propofol (3 mg/kg), fentanil (2,5 μg/kg) e lidocaína (2,5 mg/kg), i.v.; após 10 minutos de manutenção anestésica, neste grupo a dose de propofol foi reduzida em 25% (500 μg/kg/min para 375 μg/kg/min). Os parâmetros cardiorrespiratórios foram coletados 15 minutos após a medicação pré-anestésica (T...

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“…We therefore suggest that inhibitory actions of local anesthetics on I h in thalamocortical cells and cortical or hippocampal pyramidal neurons may contribute to their central anesthetic-sparing actions. In addition, because inhibition of HCN channels in sensory neurons can reduce pain sensation (Chaplan et al, 2003), it is possible that anesthetic sparing (DiFazio et al, 1976;Himes et al, 1977;Senturk et al, 2002) or analgesic actions in postoperative or neuropathic contexts (Kingery, 1997;Smith et al, 2004) could be due to effects of systemic local anesthetics on HCN1 or HCN2 subunits expressed in nociceptors (Chaplan et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

“…Lidocaine is the most important class 1B antiarrhythmic drug; it is used intravenously for the treatment of ventricular arrhythmias (Trujillo and Nolan, 2000;Pinter and Dorian, 2001). Lidocaine reduces minimal alveolar concentration of volatile anesthetics for the suppression of responses to painful stimuli in animals by 20 to 40% (DiFazio et al, 1976;Himes et al, 1977;Smith et al, 2004) and decreases the requirement of intravenous anesthetic propofol (Senturk et al, 2002). The local anesthetic lidocaine can produce ϳ0.4 minimal alveolar concentration (low-dose systemic application) (DiFazio et al, 1976) and decrease the bispectral index to 0 (higher-dose systemic application) (Gaughen and Durieux, 2006).…”

Section: Introductionmentioning

confidence: 99%

Local Anesthetic Inhibits Hyperpolarization-Activated Cationic Currents

Meng

Liu²,

Bayliss³

et al. 2011

Mol Pharmacol

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Systemic administration of local anesthetics has beneficial perioperative properties and an anesthetic-sparing and antiarrhythmic effect, although the detailed mechanisms of these actions remain unclear. In the present study, we investigated the effects of a local anesthetic, lidocaine, on hyperpolarizationactivated and cyclic nucleotide-gated (HCN) channels that contribute to the pacemaker currents in rhythmically oscillating cells of the heart and brain. Voltage-clamp recordings were used to examine the properties of cloned HCN subunit currents expressed in Xenopus laevis oocytes and human embryonic kidney (HEK) 293 cells under control condition and lidocaine administration. Lidocaine inhibited HCN1, HCN2, HCN1-HCN2, and HCN4 channel currents at 100 M in both oocytes and/or HEK 293 cells; it caused a decrease in both tonic and maximal current (ϳ30 -50% inhibition) and slowed current activation kinetics for all subunits. In addition, lidocaine evoked a hyperpolarizing shift in half-activation voltage (⌬V 1/2 of ϳϪ10 to Ϫ14 mV), but only for HCN1 and HCN1-HCN2 channels. By fitting concentration-response data to logistic functions, we estimated half-maximal (EC 50 ) concentrations of lidocaine of ϳ30 to 40 M for the shift in V 1/2 observed with HCN1 and HCN1-HCN2; for inhibition of current amplitude, calculated EC 50 values were ϳ50 to 70 M for HCN1, HCN2, and HCN1-HCN2 channels. A lidocaine metabolite, monoethylglycinexylidide (100 M), had similar inhibitory actions on HCN channels. These results indicate that lidocaine potently inhibits HCN channel subunits in dose-dependent manner over a concentration range relevant for systemic application. The ability of local anesthetics to modulate I h in central neurons may contribute to central nervous system depression, whereas effects on I f in cardiac pacemaker cells may contribute to the antiarrhythmic and/or cardiovascular toxic action.

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Effects of intramuscular administration of lidocaine or bupivacaine on induction and maintenance doses of propofol evaluated by bispectral index

Abstract: I.M. administered local anaesthetics are associated with a decrease in both the induction and maintenance doses of propofol during total i.v. anaesthesia and a reduction in haemodynamic responses.

Cited by 51 publications

References 12 publications

Comparison of 1.5% lidocaine and 0.5% ropivacaine epidural anesthesia combined with propofol general anesthesia guided by bispectral index

Comparison of 1.5% lidocaine and 0.5% ropivacaine epidural anesthesia combined with propofol general anesthesia guided by bispectral index

High doses of lidocaine as a constant rate infusion in propofol/fentanyl anaesthetized sheep: cardiorespiratory effects

Local Anesthetic Inhibits Hyperpolarization-Activated Cationic Currents

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