SUCCINYLDICHOLINE AND LIGNOCAINE BY CONTINUOUS INTRAVENOUS DRIP Report of 1000 administrations

Abstract

THE development of a technique utilising the short acting relaxant suxamethonium chloride (succinyldicholine chloride, Scoline) and the analgesic lignocaine hydrochloride (Xylocaine) followed the successful use of the combination gallamine and thi0pentone.l Scoline is an ultra short acting relaxant, and the length of action of a single dose appears to be intimately related to the level of serum cholinesterase of the recipient.2 3 4The administration of scoline by continuous intravenous drip was first described by Thesleff and von Dardel5 who used a 0.1 % solution. Green5 in a recent publication used a similar technique but in larger dosage and with controlled or aided respirations. Xylocaine, w-diethylamino-2-6 dimethyl-acetanilide, a tertiary arnine of high stability, was synthesised by Lofgren in 1943.7The absolute toxicity of xylocaine must be concluded to be slightly greater than procaine from the work by Goldberg,S who demonstrated that in concentrations of more than 0.5 % given subcutaneously in mice the toxicity was greater than procaine, and paradoxically in concentrations of less than 0.5 % equal or less than procaine.In a report by Richard Gilbert et a19 using intravenous xylocaine in obstetrics, the only toxicity witnessed transpired after prolonged and rapid administration. These untoward effects, tinnitus, facial twitchings and ankle clonus, disappeared as soon as the rate of administration was slowed. In our preliminary trials with a xylocaine drip, a case showed twitchings of the face followed by generalised convulsions, when the rate of administration was at a fast drip rate (80 dropdmin. for 15 mins.). These manifestations rapidly disappeared on cessation of the drip, and did not reappear when the drip wac recommenced at a slower rate.The marriage of scoline and xylocaine developed in the search of an equivalent to the mixture gallamine and thiopentone.The resulting hydrolysis of scoline in the presence of the alkalinity of thiopentone precluded the use of this combination. Intermittent 96

Intravenous lidocaine as adjuvant to general anesthesia in renal surgery

“…Three years later, De Clive-Lowe et al used intravenous lidocaine for the first time as adjuvant during general anesthesia. They showed that lidocaine provides post-operative analgesia with low incidence of post-operative nausea and vomiting [13]. Other studies showed that the use of lignocaine with thiopentone nitrous oxide-oxygen provide post-operative analgesia, low incidence of nausea and vomiting, and short recovery time without changes in pulse rate or blood pressure [14,15].…”

The Action of Local Anaesthetics on Experimental Epilepsy in Cats and Monkeys

“…The conclusion is that a combination of a small dose of barbiturate with lidocaine is the most effective treatment for the temporary abolition of severe epileptic fits. In this way, also, excitatory effects of lidocaine, which have very rarely been observed after injection in man (Clive-Lowe, Gray, Spencer, and North, 1954), are avoided. SUMMARY 1.…”

“…Of the others lidocaine and diethoxine were the most potent. Since lidocaine seems to be less toxic than diethoxine and since, in addition, there is considerable evidence that the intravenous injection of lidocaine in man carries little risk of complications (Clive-Lowe, Gray, Spencer and North, 1954), lidocaine was the chief drug used in our further investigations on the central effects of local anaesthetics.…”

Local anesthetic systemic toxicity

“…Three cases of convulsion were reported, and the authors emphasized the need for vigilance against toxicity. 54 Over the past 25 years, a number of randomized controlled trials (RCT) indicate that continuous intravenous lidocaine administration may have a beneficial effect on outcomes after colorectal surgery. 52,55 A recent meta-analysis of eight RCTs in patients undergoing colorectal surgery demonstrated a reduced duration of postoperative ileus, pain, nausea and vomiting, and shortened hospital stay with perioperative intravenous lidocaine administration.…”