Pharmacokinetics of lidocaïne in children with congenital heart disease

Abstract

The purpose of tt,is study was to determine the pharmacokinetics of lidocaine in children with cot,genital heart disease (CHD). Fifteen children with left to right intracardiac shunting of blood (acyanotic group) Le but de I' Etude Eta# de determiner la pharmacocinEtique de la lidocai'ne chez les enfants atteints de maladie cardiaque congdnitale (CHD). Quinze eafants ayant un shunt intracardiaque gauche-droit (groupe acyanotique) et quinze enfants avec un shunt intracardiaque droit-gauche (groupe cyanotique) ont Etd EtudiEs et compares avec 15 enfants sans CHD (groupe contrrle). La lidocai'ne (I,5 rag. kg -I ) a EtE irrjectEe dans une veine p~riphdrique en 30 sec. et des ~chantillons sEri~s de sang artEriel furant obtenus jusqu'd 120 rain. apr~s la ritz de la perfusion. La lidocai'ne totale et libre fitrent analysEes par immunoessai. La concentration sdrique de I'acide alphat glycoprotdine (at-AGP) a l'induction de I'anesthEsie fia mesur~e clans les trois groupes par immunodiffusion. Le pourcentage de lidocaine fibre (100 • [lidocai'ne] / [lidocah~e totale]) fia phts grand ~ 30 sec aprEs la perfusion dans les trois groupes (35-37%) qu'il n'Etait dans un attcun autre tetnps mais n'Etait pas significativement different parmi les trois groupes (P < 0,05In patients without congenital heart disease (CHD) 60-80% of an iv lidocaine bolus is absorbed by the lung on a first pass basis and is subsequently released with time.~-5 Patients with acyanotic CHD and left to fight (L ---} R) intracardiac shunting of blood with increased pulmonary blood flow demonstrate an abnormal circulation in that a proportion of the pulmonary venous blood returning to the heart does not pass directly to the systemic CAN J ANAESTH 1991 / 38:2 / pp 196-200

Scaling for size: some implications for paediatric anaesthesia dosing

“…Furthermore, anaesthetists and intensive care physicians are well aware of the influence major organ dysfunction involving the renal, hepatic or cardiovascular system has on drug disposition and clearance. Anaesthetists practising paediatric anaesthesia are taught about subtle changes due to surgical technique, such as reduced clearance of fentanyl after an omphalocoele repair caused by decreased hepatic function (decreased fentanyl extraction) due to raised intra‐abdominal pressure (49,50); the influence of congenital abnormalities such as left to right cardiac shunts and their possible effects on lidocaine pharmacokinetics (51,52); the increased requirement for nondepolarizing neuromuscular blocking drugs in children with malignant tumours (53); and the role of caffeine, an active metabolite of theophylline in premature neonates treated for postoperative apnoea (54).…”

Acute phase proteins altered in the plasma of patients with congenital ventricular septal defect

“…Orosomucoid 2 was also shown to inhibit platelet aggregation and to enhance the secretion of several cytokines by mononuclear cells . In addition, disease‐induced elevations of plasma alpha‐1‐acid glycoprotein is often associated with increased plasma protein binding of drugs and this has been used to determine the pharmacodynamics of drugs during surgery for congenital heart disease . Thus, the increase of orosomucoid 2 may reflect inflammation process in VSD patients that might be associated with the increased pulmonary flow.…”

The pharmacokinetics of lignocaine in humans during a computer‐controlled infusion

“…It is known that liver or heart failure (Thomson et al, 1973) possibly right to left cardiac shunts (Bokesch et al, 1987;Burrows et al, 1991), or the concurrent administration of phenobarbital (Heinonen, 1966) or propafenone (Ujhelyi et al, 1993) will alter the pharmacokinetics of lignocaine. To the authors' knowledge, these attributes did not apply to the present study population.…”