Placental transfer of lidocaine hydrochloride after prolonged continuous maternal intravenous administration

Abstract

We treated a patient with arrhythmia during pregnancy with prolonged intravenous administration of lidocaine hydrochloride. This was a case of twin-to-twin transfusionLidocaine is widely used for maternal analgesia during labour and sometimes for the treatment of arrhythmia in pregnant women. There are many reports of human placental lidocaine transfer after brief administration following maternal epidural, spinal, caudal, paracervical or pudendal analgesia during labour. However, for continuous maternal lidoeaine infusion, several studies have been reported but only in animals, t-3 There are no reports on the effects in humans of continuous maternal intravenous lidoeaine administration on fetal serum and amniotic fluid (AF) lidocaine concentrations. Since it is possible for excessive fetal serum and AF lidocaine concentrations to be produced in humans, we submit this report on a patient who received intravenous administration of lidocaine hydrochlofide for 12 days to treat arrhythmia during pregnancy. Maternal serum, fetal serum and AF lidocaine concentrations were measured at the time of delivery. Case reportA 30-yr-old woman was referred at 23 wk gestation because of preterm labour and polyhydramnios. She was CAN J ANAESTH 1995 / 42:4 / pp 338-40

A randomized study of the effects of perioperative i.v. lidocaine on hemodynamic and hormonal responses for cesarean section

“…Transport of lidocaine through the placenta has been reported. In our study, the F/M plasma concentration ratio of lidocaine at the time of delivery (0.52 ± 0.07) was similar to the reported F/M ratio values after the perineal and systemic administration of lidocaine (0.46 and 0.52, respectively), with no neonatal adverse effects [7,24]. We recorded no difference in neonatal outcome, as assessed by Apgar scores, NACS, and blood gas analyses, with the perioperative use of i.v.…”

A multidisciplinary approach to prenatal treatment of congenital long QT syndrome

“…Animal studies to determine the physiologic mechanism for the nonfunctional changes have demonstrated that G628S channels can conduct Na + , but this can be blocked by both intracellular and higher than physiologic extracellular K + . Thus, lidocaine, a sodium channel blocker that is established treatment for LQT3 (a sodium channel mutation), may be successful in treating ventricular arrhythmias associated with this particular mutation.…”

“…At 29 0/7 weeks, we added lidocaine (1 mg/kg of maternal weight followed by 1 mg/min continuous infusion) to the treatment regimen. Lidocaine, a sodium channel blocking agent, was chosen because of data suggesting that it shortens the QT interval and normalizes repolarization across the myocardium . At a dose of 1.5 mg/min (maternal serum level 2.0 μg/ml), the fetal rhythm converted to sustained sinus bradycardia (fetal heart rate 110 bpm).…”

“…Lidocaine, a sodium channel blocking agent, was chosen because of data suggesting that it shortens the QT interval and normalizes repolarization across the myocardium. 2 At a dose of 1.5 mg/min (maternal serum level 2.0 lg/ml), the fetal rhythm converted to sustained sinus bradycardia (fetal heart rate 110 bpm). Over the next 2 weeks, the fetus remained in sinus rhythm.…”

Natural Killer Cell Activity and Delivery: Possible Influence of Cortisol and Anesthetic Agents

“…This influence could be related to differences in degree of stress between vaginal and cesarean delivery [6,7] and to the fact that the drugs used in cesarean section cross the placenta and reach circulation in the fetus [8][9][10].…”