Compartmental analysis of lidocaine kinetics during extracorporeal circulation

Schiavello, R; Mezza, Antonio Di; Feo, Luis; Sciarra, Mario; Monaco, C

doi:10.1016/0888-6296(88)90307-9

Cited by 6 publications

(2 citation statements)

References 8 publications

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“…Arterial and hepatic-venous blood samples we re taken before and 5,10,15,20,25, and 30 minutes after bolus applicat ion. These blood samples we re analyzed to determin e pre-CPB lidocaine metabolite for mation.…”

Section: Modified Megx Testmentioning

confidence: 99%

Assessment of Metabolic Liver Function and Hepatic Blood Flow During Cardiopulmonary Bypass

Autschbach¹,

Falk²,

Lange³

et al. 1996

Thorac cardiovasc Surg

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A modified monoethylglycinexylidide (MEGX) test was performed in 14 patients undergoing myocardial revascularization to evaluate liver function during cardiopulmonary bypass (CPB). MEGX is the principal metabolite of lidocaine. Different studies have shown a decrease in MEGX formation in patients with impaired liver function. Following a low-dose bolus application of 0.3 mg/kgBW lidocaine MEGX concentrations were measured in five-minute intervals for half an hour. This was done once before and once during CPB. Arterial and hepatic vein blood samples were obtained in order to avoid the effects of hemodilution by CPB priming. Hepatic blood was calculated using the indocyanine green (ICG) infusion extraction technique. MEGX formation during CPB decreased. After the 10 and 15 minutes measurement points the mean arterio-hepatic venous concentrations were 61 +/- 7.2 micrograms/L and 63 +/- 7.3 micrograms/L respectively in comparison to pre-CPB values of 36 +/- 5.8 micrograms/L and 42 +/- 5.1 micrograms/L. Hepatic blood flow increased insignificantly from a mean of 835 +/- 54 ml/min prior to CPB to 913 +/- 83 ml/min during CPB. As a result the MEGX clearance calculated 15 minutes after administration of lidocaine bolus application did not differ significantly before (51.2 +/- 6.4 micrograms/min) and during CPB (40.2 +/- 5.7 micrograms/min). In conclusion, a decrease in MEGX formation was found during CPB. However, due to increased hepatic blood flow there was no significant change in MEGX clearance before and during CPB.

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Section: Modified Megx Testmentioning

confidence: 99%

Assessment of Metabolic Liver Function and Hepatic Blood Flow During Cardiopulmonary Bypass

Autschbach¹,

Falk²,

Lange³

et al. 1996

Thorac cardiovasc Surg

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“…30 minutes (i.e. Schiavello et al (1988) gave an intravenous bolus injection of lignocaine before and during cardiopulmonary bypass. As stressed by the authors themselves, the data are difficult to interpret because of the comparatively short sampling period; nevertheless, from a comparison with literature data in patients who did not undergo bypass surgery, the authors suggest an increase in volume of distribution, without change in clearance, leading to an increased elimination half-life.…”

Section: Glyceryl Trinitrate (Nitroglycerin)mentioning

confidence: 99%

Cardiopulmonary Bypass and the Pharmacokinetics of Drugs

Buylaert¹,

Herregods²,

Mortier³

et al. 1989

Clinical Pharmacokinetics

119

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Cardiopulmonary bypass is accompanied by profound changes in the organism that may alter the pharmacokinetics of drugs. Drug distribution can be altered, for example, by changes in blood flow and by haemodilution, with a decrease in protein binding; a decrease in the elimination of some drugs can be caused by impairment of renal or hepatic clearance, due, for example, to lowered perfusion and hypothermia. The subject was reviewed in the Journal in 1982, and the emphasis of the present review is on new data related to specific drugs. The following substances are dealt with: benzodiazepines, cephalosporins, digitalis glycosides, general anaesthetics, glyceryl trinitrate (nitroglycerin), lignocaine (lidocaine), muscle relaxants, nitroprusside, opiates, papaverine and propranolol. For many of these substances an abrupt decrease has been observed in serum concentration upon initiation of bypass, which is explained by haemodilution and an increase in distribution due to decreased protein binding. For nitrates and some opiates, adsorption to the bypass apparatus was shown to be important. The gradual increase in serum concentrations seen during cardiopulmonary bypass with some drugs after the initial fall is usually explained by redistribution of the drug and/or decrease in its elimination. The same phenomena are thought to explain why in the post-bypass period a concentration increase occurs, or at least a slower decrease than expected. However, drug elimination has been directly measured in only a few studies. The short duration of the bypass procedure and the continuous changes during the process hamper a rigorous pharmacokinetic evaluation. Studies allowing more precise understanding of the mechanisms underlying the observed concentration changes are needed, but are difficult to design. Similarly, more data are awaited on the pharmacodynamic and clinical consequences of the concentration changes.

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