Lidocaine metabolism pathophysiology, drug interactions, and surgical implications

Abstract

A thorough understanding of the pathophysiology of lidocaine metabolism is an important prerequisite to minimizing the risk of morbidity and mortality associated with lipoplasty. Although the tumescent technique has greatly improved the safety of large-volume lipoplasty through decreased blood loss and reduced anesthetic needs, it has introduced the possibility for lidocaine toxicity. Because lidocaine is metabolized by the cytochrome P450 system, the potential for drug interactions is heightened. These drug interactions are implicated as a cause of lidocaine toxicity. A comprehensive review of the patient's preoperative, intraoperative, and postoperative medication profile is critical to perioperative patient safety.

Evaluation of serum lidocaine/monoethylglycylxylidide concentration to assess shunt closure in dogs with extrahepatic portosystemic shunts

“…and the present study have shown that the 1 mg/kg body weight dose of lidocaine is safe in dogs with liver dysfunction, this even further decreases the risk of potential toxicity of lidocaine, without affecting the outcome of the lidocaine/MEGX test. At this moment, it is unsure what the expected bound fraction of lidocaine in dogs with EHPSS is and if this would be different in dogs with overt versus mild hepatic encephalopathy.As the activity of cytochrome P450 enzymes in the liver in humans is known to be dependent on genetic factors, age, sex, nutritional status, and drugs,15 individual variations in lidocaine metabolism are also to be expected in dogs. It has been described in healthy dogs that females have a higher concentration of MEGX 15 minutes after lidocaine administration than males; although this difference was no longer observed 30 minutes after lidocaine administration.…”

Utilization of Intravenous Lidocaine Infusion for the Treatment of Refractory Chronic Pain

“…Despite successful responses to IV lidocaine in patients with various forms of refractory chronic headache types, cardiovascular and neurological side effects remain a potential concern. Lidocaine is hepatically metabolized via the cytochrome P450 3A4 enzyme, and factors such as liver dysfunction, drug-drug interactions, and CYP3A4 genetic polymorphisms can all alter serum levels (38). Digala et al present the case of a 52-year-old woman receiving IV lidocaine infusions for the treatment of refractory hemicrania continua on several medications, including gabapentin, metformin, sertraline, and trazodone.…”

Liposuction Kemajuan Dalam Tehnik Operasi

“…13,20,21 Cara pembuatan tumescent terdiri dari lima tahap: 1) 1 liter saline atau Ringer lactate solution, 2) tambahkan lidokain 500-1000mg (10-20 ampul), 3) tambahkan epinefrin 1gr atau 1 cc (1ampul), 4) tambahkan NaHCO3 12,5 ml (10 meq/L), dan 5) bisa ditambahkan triamcinolone 10 mg. Dengan demikian dosis lidokain yang digunakan berkisar 5-10 mg/kg berat badan, dengan konsentrasi 0,4-0,8 %, sedangkan untuk konsentrasi epinefrin 1g/1000 ml (1mg/1.000.000.ml) yaitu 1/1.000.000. 1,[20][21][22][23] Selanjutnya Lillis, 1988, melaporkan bahwa dengan tehnik ini ternyata kurang dari 1% yang mengalami pendarahan. Pada tahun 1996 Moy melaporkan penggunaan lidokain untuk anaestesi lokal dengan dosis 55 mg/kg berat badan.…”

“…Pernah dilaporkan kasus yang meninggal pada pemberian dosis lidokain 75 mg/kg berat badan. 5,21,22 Gambar 18. a. Infiltrasi larutan tumescent pada bagian dalam dan luar paha. b. perbandingan ukuran microcannula berujung tumpul.…”