Abstract
The purpose of this study was to determine the pharmacokinetics of lidocaïne in children with congenital heart disease (CHD). Fifteen children with left to right intracardiac shunting of blood (acyanotic group) and 15 children with right to left intracardiac shunting of blood (cyanotic group) were studied and compared with 15 children without CHD (control group). Lidocaine (1.5 mg · kg−1) was isinjected into a peripheral vein over 30 sec and serial samples of arterial blood were obtained up to 120 min after completion of the infusion. Total and free lidocaïne were analyzed by enzyme immunoassy. The serum concentration of alpha1-acid glycoprotein (α1AGP) at induction of anaesthesia was measured in the three groups by radial immunodiffusion. The percent free lidocaïne (100 × [free lidocaïne] / [total lidocaïne]) was greater at 30 sec postinfusion in all three groups (35–37%) than it was at any other time but was not significantly different among the three groups (P < 0.05). There was no significant difference in either the percent free or the total lidocaïne concentration at any sample time or in any of the pharmacokinetic variables among the three groups. The serum concentration of α1-AGP did not differ significantly among the three groups of patients. We conclude that the presence of intracardiac shunts does not alter the pharmacokinetic behaviour of intravenous lidocaïne (1.5 mg · kg−1) in children. The percent free lidocaïne is greatest immediately postinjection and this may mitigate against rapid bolus administration of intravenous lidocaïne in children.
Résumé
Le but de l’ élude était de déterminer la pharmacocinétique de la lidocaïne chez les enfants atteints de maladie cardiaque congenitale (CHD). Quinze enfants ayant un shunt intracardiaque gauchedroit (groupe acyanotique) et quinze enfants avec un shunt intracardiaque droitgauche (groupe cyanotique) out été étudiés et comparés avec 15 enfants sans CHD (groupe contrôle). La lidocaïne (1,5 mg · kg−1) a été injectée dans une veine périphérique en 30 sec. et des échantillons sériés de sang artériel furant obtenus jusqu’ à 120 min. après la fin de la perfusion. La lidocaïne totale et libre furent analysées par immunoessai. La concentration sérique de l’ acide alpha1 glycoprotéine (α1AGP) à l’ induction de l’anesthésie fut mesurée dans les trois groupes par immunodiffusion. Le pourcentage de lidocaine libre (100 × [lidocaïne] / [lidocaine totale]) fut plus grand à 30 sec après la perfusion dans les trois groupes (35–37%) qu’il n’ était dans un aucun autre temps rnais n’ était pas significativement différent parmi les trois groupes (P < 0, 05). Il n’ y avait aucune différence significative dans soit le pourcentage de lidocaïne libre on totale dans aucun des échantillons ni dans aucune des variables pharmacocinétiques parmi les trois groupes. Les concentrations sériques de α1-AGP ne différaient pas significativement parmi les trois groupes de patients. On conclut que la présence de shunt intracardiaque n’ altère pas le comportement pharmacocinétique de la lidocaïne intraveineuse (1,5 mg · kg−1) chéz les enfants. Le pourcentage de lidocaïne libre était plus grand immediatement après l’injection et ceci nous incite à ne pas administrer la lidocaïne par un bolus rapide par voie intraveineuse chez les enfants.
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Supported with a grant from the Physicians’ Services Incorporated, Toronto, Ontario, Canada.
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Burrows, F.A., Lerman, J., LeDez, K.M. et al. Pharmacokinetics of lidocaïne in children with congenital heart disease. Can J Anaesth 38, 196–200 (1991). https://doi.org/10.1007/BF03008144
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DOI: https://doi.org/10.1007/BF03008144