Effects of Systemic Local Anesthetics on Perioperative Ischemia Reperfusion May Be Beneficial

Abstract

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. K. Hahnenkamp C. W. Hoenemann