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PEDIATRIC ANESTHESIA

Plasma Lidocaine Concentrations During Continuous Thoracic Epidural Anesthesia After Clonidine Premedication in Children

Shinichi Inomata, MD^*, Einosuke Tanaka, PhD, Masayuki Miyabe, MD^*, Yoshihiro Kakiuchi, PhD, Atsushi Nagashima, Yuichiro Yamasaki, MD^*, Shin Nakayama, MD^*, Yasuyuki Baba, BS Pharma, Hidenori Toyooka, MD^*, Kazuhiko Okuyama, MD^*, and Yukinao Kohda, PhD

*Department of Anesthesiology, Department of Legal Medicine, and Department of Clinical Pharmacy, University of Tsukuba, Tsukuba-shi, Ibaraki-ken, Japan

Address correspondence to Shinichi Inomata, MD, Department of Anesthesiology, Institute of Clinical Medicine University of Tsukuba, Tsukuba City, Ibaraki 305-8575, Japan. Address e-mail to inomatas{at}md.tsukuba.ac.jp

There is no report concerning oral clonidine’s effects on epidural lidocaine in children. Therefore, we performed a study to assess the concentrations of plasma lidocaine and its major metabolite (monoethylglycinexylidide [MEGX]) in children receiving continuous thoracic epidural anesthesia after oral clonidine premedication. Ten pediatric patients, aged 1–9 yr, were randomly allocated to the Control or Clonidine 4 µg/kg group (n = 5 each). Anesthesia was induced and maintained with sevoflurane in oxygen and air (FIO₂ 40%). Epidural puncture and tubing were carefully performed at the Th11–12 intervertebral space. An initial dose of 1% lidocaine (5 mg/kg) was injected through a catheter into the epidural space, followed by 2.5 mg · kg^-1 · h^-1. Plasma concentrations of lidocaine and MEGX were measured at 15 min, 30 min, and every 60 min for 4 h after the initiation of continuous epidural injection. The concentrations of lidocaine and MEGX were measured using high-pressure liquid chromatography with ultraviolet detection. Hemodynamic variables were similar between members of the Control and Clonidine groups during anesthesia. The Clonidine group showed significantly smaller lidocaine concentrations (p < 0.05) and the concentration of MEGX tended to be smaller in the plasma of the Clonidine group for the initial 4 h after the initiation of epidural infusion. In conclusion, oral clonidine preanesthetic medication at a dose of 4 µg/kg decreases plasma lidocaine concentration in children.

IMPLICATIONS: Oral clonidine decreases the plasma lidocaine concentration in children. Our finding may have clinical implications in patients receiving continuous epidural anesthesia. Additionally, perhaps an additional margin of safety regarding lidocaine toxicity is gained through the use of oral clonidine in children who will receive epidural lidocaine.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999