Lidocaine Toxicity Research Articles

Advancing Reduction Mammaplasty Surgery: Advancements and Outcomes with Tumescent Local Anaesthesia.

Tumescent local anaesthesia (TLA) is a method of anaesthesia used for surgical procedures that involves the infusion of a saline solution containing lidocaine, sodium bicarbonate, and epinephrine. This anaesthetic technique is designed to achieve both vasoconstriction and anaesthesia. In this article, we present a modified TLA protocol specifically adapted for reduction mammaplasty, based on an analysis of clinical case histories collected over the past few years. During the period from 2012 to 2022, we performed a reduction mammaplasty procedure in 120 patients employing tumescent local anaesthesia (TLA). The composition of the tumescent solution included 25mL of 2% lidocaine, 8mEq of sodium bicarbonate, and 1mL of epinephrine (1mg/1mL) in 1000mL of 0.9% saline solution. The solution was injected diffusely throughout the mammary gland. The average volume of tumescent solution infiltrated during TLA was 350mL per breast. There were no cases of adrenaline or lidocaine toxicity, and no patients required conversion to general anaesthesia. No patient received sedation. Patients reported no pain or discomfort during pre-operative infiltration or during surgery. No reinterventions were necessary because of short-term complications. Among the complications, there were 4 cases of hematoma (3,3%), 3 cases of seroma (2,55%), 10 cases of wound dehiscence (8,3%), 5 cases of asymmetry (4,1%), 9 cases of T-junction breakdown (7,5%), 2 cases of (partial) nipple necrosis (1,6%), and 3 cases of liponecrosis (2,5%). No cases of infection or total nipple-areola loss were reported. The follow-up period was between 30 days and 1year. Reduction mammaplasty is a viable surgical option for women with macromastia seeking to enhance their physiognomy. It is imperative that patients fully understand the potential benefits and risks associated with the procedure and consult with healthcare professionals specialising in this field. The use of tumescent local anaesthesia (TLA) has been confirmed as a safe and effective methodology to perform reduction mammaplasty, ensuring adequate pain control with minimal post-operative complications and resulting in a high degree of patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Optimizing Gynecomastia Correction Surgery: Efficacy and Safety of Tumescent Local Anesthesia Approach.

Tumescent local anesthesia (TLA) involves infusing a saline solution containing lidocaine and epinephrine into tissues to achieve localized anesthesia and vasoconstriction. While liposuction under general anesthesia remains the most used treatment, we introduce a novel TLA approach for gynecomastia surgery, drawing from our extensive experience in recent years. Between the years 2010 and 2023, we performed gynecomastia surgery on 60 male patients under TLA. The gynecomastia was treated by liposuction plus periareolar excision technique. Liposuction was carried out on both breasts in every case, regardless of whether the gynecomastia was bilateral or unilateral. The tumescent solution consisted of 25mL of 2% lidocaine, 8mEq of sodium bicarbonate, and 1mL of epinephrine (1mg/1mL) in 1000 mL of 0.9% saline solution. The solution was infiltrated between the pectoral fascia and the mammary gland, and then the surgery was carried out. The average volume of tumescent solution infiltrated during TLA was 300mL per breast. There were no reports of adrenaline or lidocaine toxicity, and no cases required a conversion to general anesthesia. Patients experienced no pain or discomfort during the preoperative infiltration or surgical procedure. We observed a major postoperative complications rate of 6.7%, represented by three incident of hematoma and one case of seroma. A minor complication rate of 5% was observed: two cases of retraction of the NAC and one case of gynecomastia recurrence, the latter undergoing an additional combination procedure with liposuction and subcutaneous mastectomy. Follow-up time ranged from 30 days to 1 year. We developed a new outpatient surgical method for gynecomastia using liposuction and periareolar excision under tumescent local anesthesia. This technique, supported by a comprehensive rehabilitation plan, proved a successful and quick recovery, and high patient satisfaction. Our results suggest it is a feasible and effective option, warranting further consideration in gynecomastia treatment strategies. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Enhancing Safety in Tumescent Liposuction: Managing Sedation-Related Respiratory Issues and Serious Complications Under Deep Sedation with the Propofol-Ketamine Protocol.

Over the past 4years, aesthetic surgery, notably liposuction, has substantially increased. Tumescent liposuction, a popular technique, has two variants-true tumescent liposuction (TTL) and semi-tumescent liposuction. While TTL reduces risks, it has limitations. There is no literature reported on semi-tumescent liposuction under deep sedation using the propofol-ketamine protocol, which is proposed as a potentially safe alternative. The retrospective analysis covered 8years and included 3094 patients performed for tumescent liposuction under deep sedation, utilizing the propofol-ketamine protocol. The evaluation of patient safety involved an examination of potential adverse events with a specific focus on respiratory issues related to sedation, including instances of mask ventilation. Among the 3094 cases, no fatalities were recorded. Noteworthy events included 43 mask ventilation instances, primarily occurring in the initial 10 min. Twelve cases experienced surgery cancellation due to various factors, including respiratory issues. Three patients were transferred to upper-level hospitals, while another three required blood transfusions. Vigilant management prevented significant complications, and other adverse events like venous thromboembolism (VTE), fat embolism, severe lidocaine toxicity, and so on were not observed. The analysis of 3094 tumescent liposuction cases highlighted the overall safety profile of the propofol-ketamine protocol under deep sedation. The scarcity of severe complications underscores its viability. The study emphasizes the significance of thorough preoperative assessments, careful patient selection, and awareness of potential complications. Prompt interventions, particularly in addressing sedation-related respiratory issues, further contribute to positive outcomes for patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Retrospective Study on Optimizing Breast Augmentation Outcomes in Transgender Patients: A Comprehensive Analysis of Tumescent Local Anesthesia Technique.

Tumescent local anesthesia (TLA) involves the infusion of a saline solution containing lidocaine and epinephrine into tissues to achieve localized anesthesia and vasoconstriction. While the use of TLA in sub-glandular augmentation mammoplasty has been documented, we present a modified TLA approach for primary sub-muscular breast augmentation in transgender patients based on our experience over the past years. Between the years 2014 and 2021, we performed primary sub-muscular breast augmentation on 20 transgender patients under TLA and conscious sedation. The tumescent solution consisted of 25mL of 2% lidocaine, 8mEq of sodium bicarbonate, and 1 mL of epinephrine (1mg/1mL) in 1000mL of 0.9% saline solution. Initially, the solution was infiltrated between the pectoral fascia and the mammary gland, and subsequently, during the surgery, under the pectoralis major muscle. The average volume of tumescent solution infiltrated during TLA was 740mL per breast. There were no reports of adrenaline or lidocaine toxicity, and no cases required a conversion to general anesthesia. Patients experienced no pain or discomfort during the preoperative infiltration or surgical procedure. Reoperations due to short-term complications never occurred. We observed a major complication rate of 5%, represented by 1 hematoma. Long-term complications comprised one case of implant dislocation and one occurrence of dystrophic scar formation. No cases of capsular contracture needing reoperation, asymmetry, and implant rupture occurred. In total, one individual (5%) requested larger implants. Follow-up time ranged from 30days to 1years. Overall, augmentation mammaplasty is a valuable choice for transgender women aiming to enhance their feminine characteristics and alleviate gender dysphoria. It is imperative for patients to conduct thorough research, grasp the potential pros and cons, and consult experienced healthcare professionals in transgender care. Additionally, tumescent local anesthesia (TLA) has proven to be a safe and efficient method for sub-muscular breast augmentation, providing effective pain control with minimal postoperative complications, resulting in high patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Serum Lidocaine Levels in Adult Patients Undergoing Cardiac Surgery With del Nido Cardioplegia

BackgroundLidocaine in del Nido cardioplegia solution prolongs the refractory period of cardiomyocytes, yielding a longer arrest per dose. Serum lidocaine concentrations >8 mg/L are associated with seizure and cardiotoxicity. We evaluated serum lidocaine concentrations in patients receiving del Nido solution during cardiac surgery. MethodsForty consecutive patients undergoing cardiac surgical procedures with del Nido cardioplegia were selected for serum lidocaine concentration measurements determined immediately after aortic cross-clamp removal. Variables included weight, body surface area, operation, cardiopulmonary bypass time, aortic cross-clamp time, and total volume of del Nido solution. The primary outcome was serum lidocaine concentration relative to total volume of del Nido solution. Descriptive statistics and Pearson correlations were computed. ResultsMedian weight was 78.3 kg (range, 43-132.4 kg), and mean body surface area was 1.9 ± 0.2 m2. Operations included coronary artery bypass grafting (n = 26 [65%]), a combination procedure (n = 5 [12.5%]), isolated mitral valve repair or replacement (n = 4 [10%]), isolated aortic valve replacement (n = 3 [7.5%]), and aortic repair or replacement (n = 2 [5%]). Median total volume of del Nido solution was 1870 mL (range, 800-5800 mL). Mean serum lidocaine concentration was 2.2 ± 0.6 mg/L. Serum lidocaine concentration was weakly correlated with del Nido solution volume (R2 = 0.21). The highest total volume of del Nido solution (5800 mL) did not yield the highest serum lidocaine concentration of 3.5 mg/L. ConclusionsSerum lidocaine concentration during cardiac surgical procedures weakly correlates with the volume of del Nido solution used and does not reach toxic levels even at high doses of del Nido solution. The results of this study may help alleviate concerns for lidocaine toxicity with high doses of del Nido solution.

Retrospective Analysis of Spontaneous Reports of Fatal Adverse Reactions Associated with Lidocaine

SCIENTIFIC RELEVANCE. Pain and pain relief are among the most important problems that arise during medical procedures. Lidocaine is used not only as an anaesthetic during interventions but also as a diluent for other medicinal products. Analysis of adverse drug reactions (ADRs) associated with lidocaine contributes to studying lidocaine toxicity and, as a result, developing measures to reduce side effects.AIM. The authors aimed to conduct a retrospective analysis of spontaneous reports of fatal ADRs associated with lidocaine.MATERIALS AND METHODS. This study analysed spontaneous ADR reports of fatal outcomes associated with lidocaine submitted to the federal ADR database in the Automated Information System of the Federal Service for Surveillance in Healthcare of the Russian Federation (Pharmacovigilance, versions 1.0 and 2.0) from 1 January 2008 to 31 December 2020.RESULTS. The ADR reports included 102 fatal outcomes associated with lidocaine. Most often, lidocaine was prescribed as a local anaesthetic or as a diluent for antibacterials. Studying the administered lidocaine doses, the authors identified several overdose cases. Most life-threatening conditions were due to hypersensitivity reactions of anaphylactic shock (54 cases, 52.9%). Lidocaine administration was accompanied by loss of consciousness, respiratory failure, and cardiac arrest in 10 cases (9.8%). Convulsions were a significant clinical sign in 9 cases (8.8%).CONCLUSIONS. Awareness of the risks of systemic toxic effects of local anaesthetics, including lidocaine, necessitates the practical implementation of certain safety measures, such as allergy skin tests before administration and mandatory monitoring of doses and patients’ well-being after administration.

Drugs That Don't Mix: Evaluating Potential Lidocaine Toxicity in the Setting of Methamphetamine Use (CS322)

Drugs That Don't Mix: Evaluating Potential Lidocaine Toxicity in the Setting of Methamphetamine Use (CS322)

Outcomes of Intramuscular Gluteal Augmentation With Implants Using Tumescent Local Anesthesia

BackgroundTumescent local anesthesia (TLA) describes the practice of injecting a very dilute solution of local anesthetic combined with epinephrine and sodium bicarbonate into the tissue until it becomes firm and tense to obtain local anesthesia and vasoconstriction. The use of TLA in augmentation intramuscular gluteoplasty has never been described for implants positioning. Advantages of the TLA technique include a reduction in blood loss through epinephrine-induced vasoconstriction and hydrostatic compression from the tumescent effect. We describe TLA technique for primary intramuscular gluteal augmentation, reporting our experience during the last 5 years.MethodsFrom 2017 to 2021, 20 patients underwent bilateral primary gluteal augmentation under TLA and conscious sedation. The tumescent solution was prepared with 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% saline solution. The solution was infiltrated with a cannula inside the gluteus maximus muscle intra-operatively.ResultsThe mean age of the patients was 39, 15 years. The average amount of tumescent solution infiltrated was 240 mL per gluteus. Operating time was 1 h and 40 min, and recovery room time averaged 240 min. Major surgery-related complications were found in 15% of patients (2 hematomas and 1 seroma) and minor complications were described in a total of 8 patients (4 wound dehiscence and 1 dystrophic scar formation). No signs of adrenaline nor lidocaine toxicity were reported and conversion to general anesthesia was never required.ConclusionsThe tumescent local anesthesia technique represents a safe and efficacious technique for performing gluteal augmentation surgery with an intramuscular implant positioning. The advantages of this technique are safety, reasonable pain control during and after surgery and a low incidence of postoperative side effects due to general anesthesia avoidance.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Adverse Outcomes in Topical Lidocaine Exposure: A Pediatric Case Series From the United States National Poison Data System.

To examine the clinical outcomes of topical lidocaine exposures in pediatric patients reported to the National Poison Data System (NPDS). We performed a retrospective review of the NPDS in pediatric patients with topical lidocaine toxicity from 2000 to 2020. Specific data analyzed were age, exposure chronicity, medical outcome, clinical effects, treatments, and disposition. Narrative case records were requested from poison centers. Of 37 cases identified, mean age was 5 years with age distribution of 1- to 0 days (n = 8), 1 to 24 months (n = 11), and 2-18 years (n = 18). Exposure chronicity was acute in 33 (89.2%) or chronic in 4 (10.8%). Moderate effects were seen in 25 (67.6%), major effects in 10 (27%), and 2 deaths (5.4%). The most common clinical effects included cyanosis (29.7%), seizures (18.9%), central nervous systems (CNS) depression (13.5%), drowsiness/lethargy (13.5%), and tachycardia (10.8%). The most common treatments were dilution/irrigation (35.1%), intravenous (IV) fluids (29.7%), oxygen (29.7%), methylene blue (27%), benzodiazepines (13.5%), and intubation (10.8%). Non-intensive care unit (ICU) disposition occurred for 23 patients (62.2%) and ICU admission for 14 (37.8%). Case details were requested for 37 cases, 16 cases (43.2%) were provided. Of the 2 deaths, 1 had significant cardiac history. The most common use of topical lidocaine was at home prior to a dermatologic procedure (37.5%). Topical lidocaine can induce serious outcomes resulting in ICU level care or death; however, moderate/major effects were well tolerated without comorbidities. Most patients discharged home. Given frequent use of topical, especially in outpatient settings, greater vigilance should be taken with prescriptions, instructions for use, and anticipatory guidance.

A randomized, double-blind, prospective study to assess lidocaine jelly for pain control during Mohs surgery

A randomized, double-blind, prospective study to assess lidocaine jelly for pain control during Mohs surgery

Safety of Lidocaine During Wide-Awake Local Anesthesia No Tourniquet for Distal Radius Plating

This study evaluated the clinical and biochemical safety profile of infiltration of lidocaine with adrenaline in wide-awake local anesthesia no tourniquet for distal radius plating. Twenty-four participants were randomly assigned to the therapeutic group (n= 19) (1% lidocaine in 1:100,000 adrenaline) and control group (n= 5) (2% lidocaine alone). Clinical parameters, including skin necrosis, duration of recovery of sensation, and lidocaine toxicity, were monitored. The serum lidocaine level was measured at different time intervals using a high-performance liquid chromatography reagent. No lidocaine toxicity was recorded in any participant. The therapeutic group had a longer time for recovery of sensation. There was a significant difference in the serum lidocaine levels between both the groups at all time intervals up to 6 hours, with all participants exhibiting serum lidocaine levels below the mild toxicity level of 6.0 μg/mL. Lidocaine used within a safe recommended dose in wide-awake local anesthesia no tourniquet for distal radius plating is clinically and biochemically safe. Determining the clinical and biochemical safety profile of lidocaine with adrenaline in wide-awake local anesthesia no tourniquet can promote wider use of this technique.

Evaluating the effects of rifampin in the prevention of neurogenic symptoms and cardiac arrhythmias caused by the systemic toxicity of lidocaine in rats.

Lidocaine toxicity is caused by unintended intravascular injection or overdose. Lidocaine is metabolized in the liver by the CYP3A4 isoenzyme. The objective was to investigate if the administration of rifampin could accelerate animal recovery and reduce the symptoms of lidocaine toxicity by induction of the CYP3A4. Thirty-six male rats were divided into control and treatment groups, each containing three subgroups. The treatment group received oral rifampin suspension daily for 1 week. In all rats, 2.00% lidocaine was injected intravenously. The first subgroup was monitored for neurological symptoms. In the second subgroup, data were recorded after the electrode was placed in the right hippocampus. Electrocardiograms were taken from the third subgroup. CYP3A4 was measured using an ELISA kit. Neurological recovery was seen after 22 and 15 min in the control and treatment groups, respectively. Rifampin also caused a significant reduction in amplitude and number of field action potentials compared to the control group. Numerous cardiac arrhythmias were observed in the control group. The mean level of CYP3A4 in the treatment group was significantly higher than in the control group. In conclusion, oral rifampin could increase the synthesis of CYP3A4, therefore, the animal recovery from lidocaine toxicity was accelerated.

Forensic medical assessment of lidocaine and bupivacaine systemic toxicity

Was to assess the lidocaine and bupivacaine systemic toxicity in forensic medical practice. The number of patients' clinical observations equal three with local anesthetic systemic toxicity (LAST) from the practice of forensic medical experts were studied, and a search of scientific publications for the last 5 years in PubMed database was conducted. The amount of publications, describing cases with LAST, equal four were selected. Differential diagnostic features between LAST and anaphylaxis were considered. The literature data about relationship between lidocaine's concentration in the blood serum and clinical features are shown. The forensic medical assessment of LAST is proposed.

Spotlight in Plastic Surgery: January 2023.

Spotlight in Plastic Surgery: January 2023.

Fatal Systemic Toxicity with Topical Lidocaine Spray

Introduction: Lidocaine is a class of Ib antiarrhythmic agent which is available in various intravenous (IV) and topical forms. Systemic toxicity of lidocaine has been reported following its IV injection or local infiltration for anesthesia, mostly. However, toxicity following the application of its topical gel and oral spray is also possible. Manifestations of lidocaine induced systemic toxicity include neurologic and cardiac symptoms. Reported cases of systemic toxicity after ingestion of topical lidocaine are rare. In this case study, we present a patient who developed symptoms of severe systemic toxicity following oral ingestion of topical lidocaine spray.Case Presentation: A young woman was referred to the emergency department with agitation following ingestion of lidocaine spray solution to commit suicide. At the time of arrival, vital signs were stable. Blood tests and electrocardiogram were also normal. She underwent supportive care. Gradually, the symptoms of neuro and cardiac toxicity appeared. Standrad management include intralipid and bicarbonate administration was unsuccesfull and the patient experienced cardiac arrest.Conclusion: Lidocaine systemic toxicity with topical form could be severe and fetal, since the prompt diagnosis of systemic toxicity is the key factor to preventing death, physicians should be familiar with the symptoms of lidocaine systemic toxicity.

Erector Spinae Plane Block is Equivalent to Tumescent Local Anesthesia for Perioperative Pain Control with Abdominal Harvest for Fat Grafting.

Background:There is increasing evidence that lidocaine is toxic to adipocytes and their precursors, which can contribute to the variability in fat graft resorption. Erector spinae plane (ESP) block is a new technique to provide analgesia of the trunk and would avoid lidocaine at the fat graft donor site. The aim of this study was to compare the efficacy of ESP block versus tumescent local anesthesia (TLA).Methods:A retrospective review was performed for all patients who underwent autologous fat grafting from the abdomen at the University of New Mexico Hospital between February 2016 and March 2019. These patients received either ESP block or TLA during abdominal fat harvest. The primary endpoints were intraoperative, postoperative, and total morphine equivalents.Results:There was no difference in the mean intraoperative, postoperative, and total morphine equivalents administered between the ESP and TLA groups.Conclusions:ESP block is equivalent to TLA for analgesia when using an abdominal donor site for fat harvest. ESP block should be considered in fat-grafting cases to avoid the potential toxicity of lidocaine to the viability of adipocytes and preadipocytes.

Suspected lidocaine toxicity and the use of metoclopramide and neostigmine to treat post‐operative small intestinal ileus in a donkey

AbstractA 17‐year‐old donkey underwent exploratory laparotomy to correct a caecal impaction via typhlotomy in combination with pelvic flexure enterotomy. Intravenous lidocaine (3 mg/kg/h; lidocaine 2% solution, BOVA Specials, London, UK) was administered throughout general anaesthesia following a loading dose (1.3 mg/kg, intravenously [IV]). The donkey recovered uneventfully. One hour after recovery, shortly after returning to the stable and commencement of lidocaine, the donkey showed ataxia, muscle fasciculations and tachycardia with progression to recumbency. Lidocaine toxicity was presumed, so the infusion was stopped and the donkey returned to standing. On Day 2 after surgery, post‐operative reflux was voluminous, so a metoclopramide infusion (0.04 mg/kg/h IV; metoclopramide 5 mg/ml injection, Siegfried Hameln, Hameln, Germany) was commenced. On Day 3, post‐operative reflux persisted, so a neostigmine infusion (0.008 mg/kg/h IV; neostigmine methylsulfate injection 2.5 mg/ml, Siegfried Hameln, Hameln, Germany) was also administered. Small intestinal motility improved by Day 5 and post‐operative reflux resolved by Day 6. Both infusions were stopped and food was re‐introduced. There was no further indication of gastrointestinal hypomotility and the donkey was discharged 11 days later.

Pentadecapeptide BPC 157 Counteracts Hemodynamic and ECG Disturbances Induced by Sotalol in Rats

Cytoprotective and organoprotective pentadecapeptide BPC 157 demonstrated particular beneficial cardiovascular effects (Curr Pharm Des. 2014;20(7):1121‐1125). Antiarrhythmic effects counteracted digoxin toxicity (Regul Pept. 2009;156(1‐3):83‐89), major blood vessel occlusions (Biomedicines 2021, 9,1029; 2021, 9,609; 2021, 9, 792) and lidocaine toxicity (Emerg Med Int. 2020;2020:6805354). Now, we reveal, by BPC 157, mitigation of hemodynamic and ECG disturbances of sotalol, a class III antiarrhythmic with non‐selective beta‐blocking activity.Albino Wistar rats received sotalol (80mg/kg, intragastrically), and at 5 min thereafter were treated with saline or BPC 157 (10ng/kg, intragastrically. Seven standard and one precordial ECG leads were recorded (baseline; after application of sotalol; and 10, 30, 90, 120 and 150 minutes after application of sotalol). Heart rate, QRS complex, PR and QT intervals were analyzed. Corrected QT intervals (QTc) were calculated according to Fridericia formula.Baseline ECG readings included average heart rate of 275.5 ± 25 bpm, average PR 54.8 ± 3.4 ms, average QRS complex 25.0 ± 4.23 ms and average QTc 166 ± 9.7 ms. Sotalol caused bradycardia (245 ± 23.5 bpm), PR prolongation (57.3 ± 2.7 ms), QRS widening (26.3 ± 3.2 ms), and QTc prolongation (173 ± 9.1 ms), measured 10 minutes after application. In BPC 157 treated animals (5 minutes after BPC‐157 application, 10 minutes after sotalol application), these effects were attenuated (heart rate 306 ± 31.7 bpm, average PR 52.3 ± 1.6 ms, average QRS 23.7 ± 5.4 ms and average QTc 159 ± 21.2 ms). This attenuation was lost in later measurements, for QRS ‐ 25 minutes after BPC 157 application, for frequency after 55 minutes, for PR after 115 minutes and for QTc after 145 minutes. In animals treated with sotalol, an increase in superior sagittal sinus pressure (10 ± 5 mmHg), as well as an increase in portal vein (17 ± 4 mmHg) and inferior caval vein pressures (12 ± 6 mmHg) were noted, along with the decrease in abdominal aortic pressure (53 ± 10 mmHg). These effects were attenuated in BPC treated animals (‐1 ± 1 mmHg for superior sagittal sinus, 7 ± 1 mmHg in portal vein, 5 ± 1 mmHg in inferior caval vein, and 81 ± 7 mmHg in abdominal aorta).In conclusion, BPC 157 attenuated deleterious hemodynamic effects of sotalol while the effects on the ECG parameters were also noted, although not long lasting, supporting the view of BPC‐157 as a rapid‐acting protective agent.

Effect of intravenous lidocaine infusion on perioperative cellular immunity and the quality of postoperative recovery in breast cancer patients: a randomized controlled trial.

Breast cancer has become the most common malignancy worldwide. Experimental and, retrospective, clinical data indicate that anaesthetic technique might influence the risk of metastasis after cancer surgery by modulating the immune system. The purpose of this study is to investigate the effect of perioperative lidocaine injection on immune cells such as T lymphocytes and natural killer cells (NK cells) and the quality of postoperative recovery in breast cancer patients and to propose new ideas and relevant theoretical evidence for the selection of anesthetic protocols for perioperative tumor patients. Women (n=68) undergoing primary breast tumour resection were randomly assigned to received 2% lidocaine (n=34; group L) or placebo (normal saline; n=34; group S). Venous blood was collected thirty minutes before surgery (T0), after tumor removal (T1), immediately after surgery (T2), 24 h after surgery (T3), and 48 h after surgery (T4). The percentages of NK cells and T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) in peripheral blood were detected by flow cytometry. Patients' quality of recovery-15 (QoR-15) scores were recorded by questionnaire before and 24 h after the operation, as well as intraoperative propofol and remifentanil dosages, the frequency of 24 h postoperative remedial analgesia, and the incidence of nausea and vomiting, dizziness, and chest tightness. There were 62 patients included in the study, and 60 patients were finally analyzed. The difference in the changing trend of NK cell levels in the 2 groups over time was statistically significant (F=7.675, P=0.008). The intraoperative changing trends of CD3+ T cells, CD4+ T cells, and the CD4+/CD8+ ratio over time differed significantly between the 2 groups of patients (P<0.05), whereas the trends of CD8+ T cells did not differ significantly (P>0.05). The QoR-15 score at 24 h after surgery was higher in Group L (128.50±20.25) than in Group S (117.50±19.50), and the difference was statistically significant (P=0.005). No adverse events such as cardiac arrhythmia and lidocaine toxicity occurred in both groups during the perioperative period. Continuous intravenous pumping of lidocaine during the perioperative period has little effect on immune function in breast cancer patients and promotes postoperative recovery. Chinese Clinical Trial Registry ChiCTR2100050445.

Balloon catheter inflation with alkalinized lidocaine reduces post-operative laryngeal pain: a prospective, randomized controlled clinical trial

Introductionles douleurs laryngées post-opératoires (DLPO) sont fréquentes et gênantes. Le but de notre travail était d´évaluer l´efficacité de l´inflation de la lidocaïne alcalinisée dans le ballonnet de la sonde d´intubation orotrachéale (SIOT) dans la prévention des DLPO.Méthodesnous avons mené une étude prospective monocentrique randomisée en double aveugle incluant des patients subissant une anesthésie générale avec IOT de durée prévue inférieure à 240 min et répartis en deux groupes équivalents: groupe lidocaïne (GL): patients dont le ballonnet de la SIOT est gonflé par la lidocaïne alcalinisée et groupe Témoin (GT): patients dont le ballonnet de la SIOT est gonflé par du sérum physiologique. Le critère de jugement principal était l´incidence des DLPO au premières 24 heures postopératoires et les critères de jugement secondaires étaient l´incidence de la toux, la dysphonie et des nausées vomissement post opératoires NVPO durant les premières 24 heures post opératoires. L´analyse statistique était réalisée par le logiciel SPSS version 25. La différence était considérée significative lorsque p < 0,05.Résultatsnous avons inclus 60 patients randomisés en 2 groupes de 30. Les 2 groupes étaient comparables par rapport à leurs critères démographiques et anesthésiques. L´inflation du ballonnet de la SIOT par la lidocaïne alcalinisée réduit l´incidence des DLPO, de la toux, de la dysphonie et des NVPO. Aucun cas de rupture du ballonnet ou de toxicité à la lidocaïne n´a été rapporté.Conclusionl´inflation du ballonnet de la SIOT par la lidocaïne alcalinisée prévient les DLPO.