Anesth Analg 2007;104:1613
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000263287.34826.0d
LETTER TO THE EDITOR
Section Editor:
Lawrence Saidman
The Sedative Effect of High Dose Lidocaine
Peter Szmuk, MD,
Alan Farrow-Gillespie, MD,
Paul Sheeran, MD, and
Tiberiu Ezri, MD
Department of Anesthesiology; University of Texas Medical School; Dallas, TX (Szmuk)
Children’s Medical Center at Dallas; Dallas, TX; Outcome Research Institute; Louisville, KY; pszmuk{at}gmail.com (Szmuk)
Department of Anesthesiology; University of Texas Medical School; Dallas, TX (Farrow-Gillespie, Sheeran)
Children’s Medical Center at Dallas; Dallas, TX (Farrow-Gillespie, Sheeran)
Department of Anesthesia; The Edith Wolfson Medical Center, Holon; Affiliated to Sackler Medical School; Tel Aviv University, Israel (Ezri)
Outcome Research Institute; Louisville, KY (Ezri)
To the Editor:
In their case report Gaughen and Durieux (1) report hypotension, and a BIS value of zero in a 75-yr-old woman who received an unintended infusion of 800 mg of lidocaine over 8 min while also anesthetized with sevoflurane. Following recovery, weakness persisted for more than an hour. We would like to support their findings with our experience. A few years ago one of us (PS) together with eight other anesthesiologists took part as volunteers in a clinical study of the effects of IV lidocaine on pain perception (unpublished data). We received 1 mg/kg IV lidocaine as a bolus, followed by an infusion of 5 mg/kg over 2 hr. Even though the blood lidocaine concentrations were less than that associated with toxicity (5 µg/mL) (2), all subjects reported deep sedation, and muscle weakness. Some had speech disturbances and diplopia but none reported tinnitus or metallic taste.
The presence of sedation as an early sign of lidocaine toxicity is not well documented in the anesthetic literature even though it has been described elsewhere (3).
We suggest monitoring for sedation during lidocaine (and possible other local anesthetics) administration as an early sign of a high blood concentration. Using BIS in these cases might provide an objective measurement of the level of sedation.
REFERENCES
- Gaughen CM, Durieux M. The effect of too much intravenous lidocaine on bispectral index. Anesth Analg 2006;103:1464–5.[Abstract/Free Full Text]
- Wallace MS, Ridgeway BM, Leung AY, et al. Concentration-effect relationship of intravenous lidocaine on the allodynia of complex regional pain syndrome types I and II. Anesthesiology 2000;92:75–83.[Web of Science][Medline]
- Tremont-Lukats IW, Hutson PR, Backonja MM. A randomized, double-masked, placebo-controlled pilot trial of extended IV lidocaine infusion for relief of ongoing neuropathic pain. Clin J Pain 2006;22:266–71.[Web of Science][Medline]
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