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J Cardiothorac Vasc Anesth. 2011 Dec;25(6):931-6. doi: 10.1053/j.jvca.2011.03.008. Epub 2011 May 25.

Population pharmacokinetics of lidocaine administered during and after cardiac surgery.

Author information

1
Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan. hsumd@ms1.mmh.org.tw

Abstract

OBJECTIVE:

The objective of this study was to determine the pharmacokinetics of lidocaine in a 48-hour infusion in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).

DESIGN:

A retrospective substudy of a clinical trial assessing the efficacy of intravenous lidocaine for postoperative cognitive decline.

SETTING:

A university hospital.

PARTICIPANTS:

Ninety-nine patients undergoing cardiac surgery with CPB.

INTERVENTIONS:

After the induction of anesthesia, lidocaine was administered as a bolus of 1 mg/kg and followed by a continuous infusion at 4 mg/min for the 1st hour, 2 mg/min for the 2nd hour, and 1 mg/min for the next 46 hours.

MEASUREMENTS AND MAIN RESULTS:

Blood samples were taken at baseline, the end of CPB, and 24 and 48 hours after CPB for the measurement of the plasma concentration of lidocaine. Lidocaine levels increased significantly over time despite a constant rate of infusion (p < 0.05). The pharmacokinetics of lidocaine was best described by a 2-compartment model, and body weight was found to be a significant factor for the volume of the central compartment and clearance. The final pharmacokinetic parameters were V(1)(L) = 0.0619*weight, V(2)(L) = 187, CL(1) (L/min) = 0.00419*weight, and CL(2) (L/min) = 8.92.

CONCLUSIONS:

A 2-compartment pharmacokinetic model best describes the plasma concentrations of a 48-hour lidocaine infusion in patients undergoing cardiac surgery with CPB. The inclusion of body weight as a covariate on clearance and central compartment improves the model. Lidocaine infusions should be dosed by body weight and decreased after 24 hours to avoid potential toxicity in long-term infusions.

PMID:
21616681
PMCID:
PMC3203309
DOI:
10.1053/j.jvca.2011.03.008
[Indexed for MEDLINE]
Free PMC Article

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