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Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland
To the Editor:
We read with interest the article by Hahnenkamp et al. (1). The authors describe beneficial effects of local anesthetics, including 1) attenuating the perioperative stress response, 2) decreasing the incidence of vascular graft occlusion and thromboembolic complications, 3) inhibitory effects on platelet aggregation, and 4) antiinflammatory effects. As indicated by the authors, these events and their manipulation are important for patient outcome, with further studies required to clarify the systemic effects of local anesthetics in the perioperative period (1).
Ischemia reperfusion is an important event in the perioperative period, with such injury consequent to surgeries such as aortic (2), cardiac (3), orthopedic, and plastic surgery (4). Local anesthetics in vitro are beneficial in animal models of ischemia reperfusion (5,6). Potential therapeutic mechanisms include antiinflammatory (7) and antioxidant actions (8). The role of local anesthetics and ischemia reperfusion in the perioperative period has not been studied. Studies of the effects of systemic local anesthetics in the perioperative period should also examine this possible beneficial effect. The authors did not discuss this important perioperative event and the likely benefit of local anesthetics.
References
Department of Anaesthesiology and Intensive Care, University Hospital Muenster, Münster, Germany
In Response:
We thank Drs. Harmon and Lan for their interest in our review and for their thoughts concerning the effects of local anesthetics besides their ability to block Na+ channels. We had to restrict our manuscript on local anesthetic effects on perioperative coagulation, inflammation, and microcirculation (1) because of the restricted information and therefore were not able to cover influences of local anesthetic on all perioperative aspects.
We agree completely that the role of local anesthetics in ischemia reperfusion is unclear and has not yet been elucidated in detail. Some studies report local anesthetic effects on myocardial infarction and reperfusion of the ischemic heart. Although the discussion is still controversial (2), experiments of myocardial ischemia in a porcine (3) and a dog model (4) have shown that lidocaine preserved the ischemic myocardium and was able to reduce infarct size. This effect may be a result of antiinflammatory effects of lidocaine in areas of myocardial infarction or stunned myocardium.
We thank Drs. Harmon and Lan for their most interesting comment on our review and fully support their view that these effects of systemic local anesthetics on perioperative ischemia reperfusion should be studied in more detail, especially as local anesthetics are probably the most commonly used compounds in anesthesia. They are safe, have an infrequent rate of side effects, and are easy to use.
References
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