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 transfusion syndrome and the arrhythmia was caused by ritodrine therapy. In total, 14.1 g lidocaine (50 mg · hr−1 for 282 hr) were used. Since there are no descriptions of human placental transfer of lidocaine after such a prolonged continuous intravenous administration, we measured lidocaine concentrations in maternal and fetal serum, and in the amniotic fluid (AF) at delivery. Fetal serum lidocaine concentrations (donor: 0.83 μg · ml−1; recipient: 0.82 μg · ml−1) were lower than in the maternal serum (1.6 μg · ml−1), while the AF lidocaine concentrations (donor: 1.05 μg · ml−1; recipient: 1.04 μg · ml−1) were higher than those of the fetal sera. The fetal/maternal concentration ratios of lidocaine were 0.52 for the donor and 0.51 for the recipient, which were similar to those described previously after administration of lidocaine in labour.

Résumé

Nous avons traité l’arythmie d’une parturiente porteuse de jumeaux avec de l’hydrochlorure lidocaline iv. Il s’agissait d’un syndrome de gémellité perfuseur-perfusé et l’arythmie était consécutive au traitement à la ritodrine. En tout, 14,1 g (50 mg · h−1 pour 282 h) de lidocaine ont été administrées. Comme on n’a jamais rapporté de données sur le transfert placentaire de la lidocaïne après une administration iv aussi prolongée, nous avons mesuré à l’accouchement les concentrations sériques maternelles et foetales de lidocaïne, et la concentration sérique de liquide amniotique (LA) de lidocaïne. Les concentrations sériques (perjuseur: 0,83 μg · ml−1; perfusé: 0,82 μg · ml−1) étaient moins élevées que dans le sérum matemel (1,6 μg · ml−1), alors que dans le LA (perfuseur: 1,05 μg · ml−1; perfusé; 1.04 μg · ml−1) les concentrations étaient plus élevées que dans le sérum foetal. Les rapports concentration foetus/ mère de lidocaïne étaient de 0,52 pour le perfuseur et de 0,51 pour le perfusé et identiques à ceux trouvés après l’administration de lidocaïne pendant le travail.

References

  1. 1

    Pedersen H, Santos AC, Morishima HO, et al. Does gestational age affect the pharmacokinetics and pharmacodynamics of lidocaine in mother and fetus? Anesthesiology 1988; 68: 367–72.

    PubMed  Article  CAS  Google Scholar 

  2. 2

    Kennedy RL, Bell JU, Miller RP, et al. Uptake and distribution of lidocaine in fetal lambs. Anesthesiology 1990; 72: 483–9.

    PubMed  Article  CAS  Google Scholar 

  3. 3

    Smedstad KG, Morison DH, Harris WH, Pascoe P. Placental transfer of local anaesthetics in the premature sheep fetus. International Journal of Obstetric Anesthesia 1993; 2: 34–8.

    PubMed  Article  CAS  Google Scholar 

  4. 4

    Benedetti TJ. Maternal complications of parenteral β-sympathomimetic therapy for premature labor. Am J Obstet Gynecol 1983; 145: 1–6.

    PubMed  CAS  Google Scholar 

  5. 5

    Winn HN, Gabrielli S, Reece EA, Roberts JA, Salafia C, Hobbins JC. Ultrasonographic criteria for the prenatal diagnosis of placental chorionicity in twin gestations. Am J Obstet Gynecol 1989; 161: 1540–2.

    PubMed  CAS  Google Scholar 

  6. 6

    Bertol E, Mari F, Torracca F. Comparison of lidocaine by fluorescence polarization immunoassay, enzyme immunoassay, and high resolution gas chromatography. J Anal Toxicol 1987; 11: 122–6.

    PubMed  CAS  Google Scholar 

  7. 7

    Ralston DH, Shnider SM. The fetal and neonatal effects of regional anesthesia in obstetrics. Anesthesiology 1978; 48: 34–64.

    PubMed  Article  CAS  Google Scholar 

  8. 8

    Guay J, Gaudreault P, Boulanger A, Tang A, Lortie L, Dupuis C. Lidocaine hydrocarbonate and lidocaine hydrochloride for cesarean section: transplacental passage and neonatal effects. Acta Anaesthesiol Scand 1992; 36: 722–7.

    PubMed  CAS  Article  Google Scholar 

  9. 9

    Loftus JR, Holbrook RH, Cohen SE. Fetal heart rate after epidural lidocaine and bupivacaine for elective cesarean section. Anesthesiology 1991; 75: 406–12.

    PubMed  Article  CAS  Google Scholar 

  10. 10

    Kileff ME, James FM III, Dewan DM, Floyd HM. Neonatal neurobehavioral responses after epidural anesthesia for cesarean section using lidocaine and bupivacaine. Anesth Analg 1984; 63: 413–7.

    PubMed  Article  CAS  Google Scholar 

  11. 11

    Abboud TK, Afrasiabi A, Sarkis F, et al. Continuous infusion epidural analgesia in parturients receiving bupivacaine, chloroprocaine, or lidocaine — maternal, fetal, and neonatal effects. Anesth Analg 1984; 63: 421–8.

    PubMed  CAS  Google Scholar 

  12. 12

    Abboud TK, Sarkis F, Blikian A, Varakian L, Earl S, Henriksen E. Lack of adverse neonatal neurobehavioral effects of lidocaine. Anesth Analg 1983; 62: 473–5.

    PubMed  CAS  Google Scholar 

  13. 13

    Abboud TK, Kim KC, Noueihed R, et al. Epidural bupivacaine, chloroprocaine, or lidocaine for cesarean section — maternal and neonatal effects. Anesth Analg 1983; 62: 914–9.

    PubMed  CAS  Google Scholar 

  14. 14

    Datta S, Houle GL, Fox GS. Concentration of lidocaine hydrochloride in newborn gastric fluid after elective Caesarean section and vaginal delivery with epidural analgesia. Can Anaesth Soc J 1975; 22: 79–83.

    PubMed  Article  CAS  Google Scholar 

  15. 15

    Scanlon JW, Brown WU, Weiss JB, Alper MH. Neurobehavioral responses of newborn infants after maternal epidural anesthesia. Anesthesiology 1974; 40: 121–8.

    PubMed  Article  CAS  Google Scholar 

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Correspondence to Michio Banzai.

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Banzai, M., Sato, S., Tezuka, N. et al. Placental transfer of lidocaine hydrochloride after prolonged continuous maternal intravenous administration. Can J Anaesth 42, 338 (1995). https://doi.org/10.1007/BF03010711

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Key Words

  • anaesthesia: obstetric
  • anaesthetics, local: lidocaine
  • uterus: tocolytics, ritodrine
  • complication: arrhythmia
  • pharmacokinetics: placental transfer, serum concentration
  • placenta: drug transfer