Intravenous lidocaine infusion therapy and intraoperative neurophysiological monitoring in adolescents undergoing idiopathic scoliosis correction: A retrospective study.

BACKGROUND: Posterior spinal instrumentation and fusion is an established surgical procedure for the correction of adolescent idiopathic scoliosis. Intraoperative neurophysiological monitoring is standard practice for this procedure. Anesthetic agents can have different, but significant, effects on neurophysiological monitoring outcomes. AIM: To determine if intravenous lidocaine infusion therapy has an impact on the intraoperative neurophysiological monitoring during posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis. METHODS: Following ethical approval, we conducted a retrospective review of charts and the archived intraoperative neurophysiological data of adolescents undergoing posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis. Intraoperative neurophysiological monitoring data included the amplitude of motor evoked potentials and the amplitude and latency of somatosensory evoked potentials. A cohort who received intraoperative lidocaine infusion were compared to those who did not. RESULTS: Eighty-one patients were included in this analysis, who had surgery between February 4, 2016 and April 22, 2021: 39 had intraoperative intravenous lidocaine infusion and 42 did not. Based on hourly snapshot data, there was no evidence that lidocaine infusion had a detrimental effect on the measured change from baseline for MEP amplitudes in either lower (mean difference 41.9; 95% confidence interval -304.5 to 388.3; p = .182) or upper limbs (MD -279.0; 95% CI -562.5 to 4.4; p = .054). There was also no evidence of any effect on the measured change from baseline for SSEP amplitudes in either lower (MD 16.4; 95% CI -17.7 to 50.5; p = .345) or upper limbs (MD -2.4; 95% CI -14.5 to 9.8; p = .701). Finally, there was no evidence of a difference in time to first reportable neurophysiological event (hazard ratio 1.13; 95% CI 0.61 to 2.09; p = .680). CONCLUSIONS: Data from these two cohorts provide preliminary evidence that intravenous lidocaine infusion has no negative impact on intraoperative neurophysiological monitoring during PSIF for adolescent idiopathic scoliosis.

Comparing the Efficacy of 8.4% and 7.5% Buffered Lidocaine during Surgical Removal of Impacted Mandibular Third Molar- A Split Mouth Double Blinded Randomized Controlled Study.

Statement of the Problem: Conventional injection technique with adrenaline during removal of impacted third molar of mandible had proportionally increased pain during administration with slow onset of action and shorter duration of anesthesia. Purpose: The purpose of this study was to compare the effective nature of 8.4% and 7.5% buffered lidocaine hydrochloride during surgical removal of mandibular impacted third molar. Materials and Method: This prospective crossover study included 50 patients requiring bilateral removal of impacted mandibular third molars. Group I included 50 impacted mandibular third molars that were administered with 8.4% buffered lidocaine hydrochloride and group II included 50 impacted mandibular third molars were administered with 7.5% buffered lidocaine hydrochloride. The outcome variables were pain on injection, time of onset of anesthesia, and duration of action of anesthesia. The above parameters were recorded by the investigator and statistically analyzed through Chi-square test using SPSS software. Results: Patients in group I had mild pain (1.02) and patients in group II (5.74) had moderate pain with a statistical significance of p< 0.05 for group I respectively. The mean onset of action of anesthesia in group I was 0.08 seconds and 0.59 seconds in group II (p< 0.05). The duration of anesthesia was 342.51 minutes from group I and 122.06 minutes in group II (p< 0.05) respectively. Conclusion: Lidocaine hydrochloride buffered with 8.4 % sodium bicarbonate was found to be more effective in reduction of pain during injection, also had a faster onset of action and longer duration of the action of anesthesia when compared to 7.5% buffered lidocaine hydrochloride.

Lidocaine inhibits the lung cancer progression through decreasing the HIST1H2BL levels via SIRT5 mediated succinylation.

Lung cancer is a malignant tumor originating from the bronchial mucosa or gland of the lung. Recently, lidocaine, a widely used amide local anesthetic, was demonstrated to inhibit many cancer progression. This research was performed to explore the specific mechanism of lidocaine in the lung cancer progression. The human normal lung epithelial cells (BEAS-2B), and NSCLC cell lines (A549 and H1299) were used and treated with lidocaine in this study. The cell biological behaviors were detected by CCK-8, wound healing and transwell assay. Besides, the mRNA and protein levels of related genes were detected by western blot. The results showed that lidocaine treatment significantly decreased the cell viability and migration of the A549 and H1299 cells. Furthermore, the lidocaine treatment significantly decreased the succinylation and protein levels of HIST1H2BL, which was reversed after SIRT5 knockdown. Additionally, HIST1H2BL knockdown decreased the cell viability and migration of the A549 and H1299 cells, while HIST1H2BL overexpression reversed the effects of lidocaine on the cell viability and migration of the A549 and H1299 cells. In conclusion, lidocaine treatment might inhibited the lung cancer progression through decreasing the SIRT5 mediated succinylation of HIST1H2BL.

Comparative Evaluation of the Efficacy and Onset of Local Anesthesia Using Buffered 2% Lidocaine with 1:100,000 Adrenaline, Non-buffered 2% Lidocaine with 1:100,000 Adrenaline, Buffered 4% Articaine with 1:100,000 Adrenaline and Non-buffered 4% Articaine with 1:100,000 Adrenaline in Dental Extraction.

Aim: To compare the efficacy and onset of local anesthesia using buffered versus non-buffered 2% lidocaine with 1:100,000 adrenaline and 4% articaine with 1:100,000 adrenaline in dental extraction. Methodology: A prospective, clinical study was carried out in oral and maxillofacial surgery department. Twenty-eight patients were considered in the study and were divided into 4 groups. Each group randomly received either buffered 2% lidocaine with 1:100,000 adrenaline, non-buffered 2% lidocaine with 1:100,000 adrenaline, buffered 4% articaine with 1:100,000 adrenaline or non-buffered 4% articaine with 1:100,000 adrenaline. The outcome variable was onset of anesthesia and effectiveness of anesthesia in buffered and non-buffered group. Results: Results showed that the mean onset of time and efficacy of local anesthesia was significantly better in buffered when compared with non-buffered local anesthetic solution with adrenaline. Conclusion: In conclusion, the addition of sodium bicarbonate as a buffering agent decreases time of onset and increases the effectiveness of local anesthetics, thus providing comfort to the patient. The mean onset of time for first symptom as well as lip numbness was more for non-buffered lidocaine followed by non-buffered articaine, buffered lidocaine and buffered articaine. The mean onset of time for subjective and objective symptoms was more for non-buffered anesthetic solution as compared to buffered anesthetic solution. VAS readings were not statistically significant among the four groups.

"Can Perioperative Intravenous Lidocaine Decrease Postoperative Pain After Oral and Maxillofacial Surgeries?": A Randomized Clinical Trial.

Purpose: To determine the efficacy of perioperative intravenous lidocaine in decreasing postoperative pain after oral and maxillofacial surgeries. Methods: Forty patients undergoing various oral and maxillofacial surgeries under general anesthesia were recruited in this prospective, randomized, double blinded controlled trial. Lidocaine group received Lidocaine 2.0%, whereas the control group received Normal saline 0.9% infusion. Pain intensity, sedation, vitals and side effects were assessed at 2 h, 4 h, 6 h, 12 h and 24 h postoperatively. Results: Twenty patients were assigned to each group. There were no significant differences between the groups for the study variables at baseline. The median Numeric Rating Scale (NRS) pain scores were higher in normal saline group than lidocaine group at 2 h, 4 h and 6 h and same at 12and 24 h; however, the differences were not statistically significant. Mean (± SD) analgesic consumed in lidocaine group was 47.37 (± 42.80) mg and 69.47(± 36.13) mg in saline group, which was not significant either. Similarly, no statically significant difference was observed for sedation and vitals at all the time intervals. Conclusion: Perioperative infusion of low dose lidocaine does not have significant effect on reduction in postoperative pain intensity and analgesic consumption, in patients undergoing oral and maxillofacial surgeries. Trail registered at clinicaltrials.gov (NCT03479320).

Perioperative intravenous lignocaine for pediatric postoperative pain-A systematic review and meta-analysis.

BACKGROUND: Intravenous lignocaine has been used as an analgesic adjunct in pediatric surgical patients, although its efficacy is still unclear. OBJECTIVE: We aimed to clarify the efficacy of perioperative intravenous lignocaine (bolus followed by an infusion) on pediatric postoperative pain outcomes. DESIGN: A systematic review and meta-analysis. DATA SOURCES: PubMed, EMBASE, Web of Science, Google Scholar (inception to June 2024). ELIGIBILITY CRITERIA: Studies involving pediatric patients (≤18 years) undergoing surgery under general anesthesia with one group receiving perioperative intravenous lignocaine (bolus followed by infusion) and the other group receiving placebo. The primary outcome was 24-h postoperative opioid consumption. Postoperative pain scores and the need for rescue analgesia were the secondary outcomes. RESULTS: Seven studies (n = 415) were included in the final meta-analysis. The use of intravenous lignocaine significantly reduced the morphine consumption in the first 24 h after surgery, compared to placebo (SMD -1.31, 95% CI -2.18 to -0.43, p = 0.003). A meta-analysis could not be performed for the secondary outcomes. CONCLUSION: There is low quality evidence to suggest that perioperative intravenous lignocaine bolus followed by an infusion significantly reduced the opioid consumption on the first postoperative day in pediatric surgical patients. The effects of perioperative lignocaine on postoperative pain scores and the need for rescue analgesia are uncertain.

Comparing postoperative pain relief: ketorolac and Nasocalcin spray versus lidocaine and Nasocalcin spray in abdominal surgery patients.

Objectives: Postoperative pain management is critical for patient recovery after abdominal surgery. This study compared intravenous lidocaine and ketorolac for reducing postoperative pain and opioid use, along with Nasocalcin nasal spray. Methods: In this randomized controlled trial, 58 abdominal surgery patients were allocated to receive either intravenous lidocaine plus Nasocalcin spray (n=29) or intravenous ketorolac plus Nasocalcin spray (n=29) before surgery. Pain intensity (visual analog scale) and postoperative opioid consumption were assessed at 1, 6, 12, and 24 h after surgery. Results: Patients receiving ketorolac plus Nasocalcin spray reported significantly lower pain scores at all time points compared to lidocaine plus Nasocalcin (P<0.001). Average 24-h pain scores were 4.5 with ketorolac versus 5.1 with lidocaine. Mean opioid consumption was also lower in the ketorolac group (31.9 mg) versus the lidocaine group (43.9 mg, P<0.001). Conclusion: Preoperative ketorolac plus Nasocalcin nasal spray resulted in superior pain relief and less opioid use compared to lidocaine plus Nasocalcin after abdominal surgery. Ketorolac may be a more effective analgesic option, while Nasocalcin spray is a safe adjunct. These findings can inform clinical practice for optimizing postoperative analgesia.

Comparison of lidocaine bicarbonate with fentanyl and chloroprocaine for epidural anesthesia during cesarean section: a randomized, controlled, double-blind clinical trial.

Chloroprocaine and lidocaine bicarbonate are commonly used for epidural anesthesia because of their rapid onset, particularly in the case of conversion from epidural labor analgesia to emergency cesarean section. However, it is unclear whether lidocaine bicarbonate combined with fentanyl has an advantage over chloroprocaine alone in emergency cesarean section. In this study, 102 women who underwent elective cesarean section received 15 mL 3% chloroprocaine and 1 mL saline (CP group) or 15 mL 1.73% lidocaine bicarbonate and 1 mL fentanyl 50 µg (LF group) for epidural anesthesia. Nociceptive block level was assessed by pinprick and recorded every minute. The primary outcome was the onset time to T6 block. The median onset time to T6 analgesia was 10 [10, 10] min in the CP group and 10 [7, 10] min in the LF group (COX model for CP versus LF, HR 0.47, 95% CI 0.23-0.95, p = 0.035). The median onset time to T8 analgesia was 7 [5, 9] min in CP group and 5 [4, 7] min in LF group (COX model for CP versus LF, HR 0.61, 95% CI 0.39-0.95, p = 0.027). The proportion of hypotension episodes occurring before delivery in LF group was lower than that in CP group (p = 0.011). The incidence of block level ≥ T4 after supplemental dosing in the LF group was lower than that in the CP group (p = 0.031). Compared with 3% chloroprocaine, 1.73% lidocaine bicarbonate combined with fentanyl 50 µg has a slightly faster onset time and less hypotension in epidural anesthesia for cesarean section. Clinical Trial Registration: http://www.chictr.org.cn/index.html, identifier ChiCTR2200056180.

An Evaluation of Skin and Immunological Responses after Using a Novel Cross-Linked Porcine-Based Dermal Injectable Collagen with Lidocaine for Nasolabial Fold Correction.

Background: Hypersensitivity to the new dermal injectable porcine-based collagen with lidocaine featuring a novel cross-linking technology (test filler) for nasolabial fold correction was compared to the commercially available traditional cross-linked dermal injectable porcine-based collagen with lidocaine (control filler). Methods: Recruited participants (n = 279) received a single 0.1 mL intradermal injection of either test filler or control filler in the left forearm as a screening skin allergy test. Injection sites were assessed clinically at 24 h post-implant. Treatment was given to 252 successfully screened participants, and injection sites were monitored for 21 days. Immunological examinations were performed at screening and then at 4 and 24 weeks post-treatment. Observations for adverse events continued until the 52nd week. Results: Intradermal allergy testing results were negative for all the test recipients (0/124) and positive for two control recipients (2/132, 1.5%). Most of the participants exhibited no changes in serum immunoglobulin (IgG, IgM) and complement (C3, C4) levels. No serious adverse events related to the device were recorded. Most adverse events were common complications of dermal filler treatment and were related to the injection site. Most adverse effects were resolved or under control by 52 weeks. Conclusions: Hypersensitivity reactions with the test filler were lower than those with the control filler, validating the safe use of test filler for nasolabial fold correction without the need for pretreatment skin testing.

Lidocaine combined with general anesthetics impedes metastasis of breast cancer cells via inhibition of TGF-ß/Smad-mediated EMT signaling by reprogramming tumor-associated macrophages.

Surgical resection is the best-known approach for breast cancer treatment. However, post-operative metastases increase the rate of death. The potential effect of anesthetic drugs on long-term tumor growth, risk of metastasis, and recurrence after surgery has been investigated in cancer patients. However, the underlying mechanisms remain unclear. Therefore, we aimed to elucidate the anti-metastatic effect of lidocaine combined with common anesthetics and its mechanisms of action on lung metastasis in breast cancer models. The combination of lidocaine with propofol or sevoflurane inhibited the growth of TNBC cells compared to treatment alone. In addition, the combination effectively inhibited cancer cell migration and invasion. It suppressed tumor growth and increased the survival rate in breast 4 T1 orthotopic models. More importantly, it inhibited lung metastasis and recurrence compared with groups treated with a single anesthetic. In co-culture with TAMs and TNBC cells, lidocaine not only reduced M2-tumor-associated macrophages (TAM) that were increased by sevoflurane or propofol but also increased M1 macrophage polarization, impeding tumor growth in TNBC. Also, we found that the transforming growth factor-ß (TGF-ß) derived from TAMs increased EMT signaling in TNBC cells, and that lidocaine affected cancer cells as well as M2-TAMs, inducing M2 to M1 reprogramming and decreasing TGF-ß/Smads-mediated EMT signaling in TNBC cells, leading to inhibition of cancer metastasis and recurrence. These findings suggest lidocaine combined with general anesthetics as a potential therapeutic approach for the inhibition of recurrence and metastasis of breast cancer patients undergoing curative resection.

Topical larynx lidocaine Spraying reduces cardiovascular stress response caused by suspension laryngoscopic surgery.

OBJECTIVE: This study aimed to investigate the potential reduction of cardiovascular stress response caused by suspension laryngoscopic surgery through the application of lidocaine spray on the larynx and trachea. METHODS: A total of 68 patients scheduled for elective suspension laryngoscopic surgery were randomly assigned to either the lidocaine group (Group L, n = 34) or the control group (Group C, n = 33). In Group L, patients received a sprayed lidocaine dose of 2 mg/kg on the larynx and trachea after anesthesia induction, prior to intubation. In Group C, equal volumes of saline solution were administered. MAP and HR were recorded at various time points: before anesthesia (T0), 1-minute after intubation (T1), 1 and 3 min after suspension laryngoscopy (T2 and T3), at the end of the operation (T4), and at 1, 5, and 30 min after extubation (T5, T6, and T7). Arterial blood glucose, epinephrine, and norepinephrine levels were measured at T0, T2, T5, and T7. The occurrence of severe cough and sore throat at T6 and T7 after extubation was compared between the two groups. RESULTS: At T0 and T1, there were no statistically significant differences in mean arterial pressures, heart rate, and blood catecholamine levels between the two groups. However, from T2 to T7, the blood pressure and heart rate in Group L were lower compared to Group C, with significant differences observed at T2‒T6 (p < 0.05). Group L also showed less elevation in blood glucose at T2, T5, and T7 (p < 0.05). The changes in epinephrine and norepinephrine levels between the two groups were statistically significant at T2 and T5 (p < 0.05). CONCLUSIONS: Administering lidocaine spray on the larynx and trachea during intubation for suspension laryngoscopic surgery can effectively alleviate the stress response. LEVEL 1 EVIDENCE: Patients in this study are randomly assigned to the treatment or control group and are followed prospectively.

Simulated bupivacaine pharmacokinetics after labor epidural analgesia followed by transversus abdominis plane block with liposomal bupivacaine for intrapartum cesarean delivery.

STUDY OBJECTIVE: To simulate bupivacaine pharmacokinetics in scenarios of labor epidural analgesia (LEA) extended for intrapartum cesarean delivery (CD) with epidural or intrathecal boluses, followed by transversus abdominis plane (TAP) block with liposomal bupivacaine (LB) for postcesarean analgesia. DESIGN: Bupivacaine plasma concentrations were simulated using a 2-compartment distribution model fit to previous study data. SETTING: Virtual pharmacokinetic simulations. PATIENTS: Virtual individuals (1000, each scenario) had uniform weight (80 kg) but varying absorption parameters. INTERVENTIONS: The 6 scenarios varied in LEA infusion duration (6 or 24 h), local anesthetic used for bolus to extend LEA (epidural lidocaine or intrathecal bupivacaine), TAP block regimen, and time between bolus and TAP block. MEASUREMENTS: Scenario outcomes included geometric mean (GM) peak bupivacaine plasma concentration (Cmax) with 95% prediction interval (PI), median (range) Cmax, and number of virtual individuals (per 1000) with Cmax reaching estimated toxicity thresholds (neurotoxicity: 2000 µg/L; cardiotoxicity: 4000 µg/L). MAIN RESULTS: In simulated scenarios of LEA infusion for 24 h with an epidural bolus of lidocaine 400 mg for CD followed 1 h later by TAP block, the GM Cmax for the scenarios with TAP blocks including either LB 266 mg plus bupivacaine hydrochloride 52 mg or bupivacaine hydrochloride 104 mg was 1860 (95% PI, 1107-3124) and 1851 (95% PI, 1085-3157) µg/L, respectively. Among 1000 virtual individuals for each scenario, 404 and 401 had Cmax reaching 2000 µg/L, respectively; 1 and 0 had Cmax reaching 4000 µg/L, respectively. For other scenarios, GM Cmax remained <1000 µg/L. CONCLUSIONS: Across 6 different simulations of TAP blocks for intrapartum CD analgesia, LEA with bupivacaine (with or without boluses for extension and including a conservative modeling of lidocaine without epinephrine), followed by TAP block with LB and/or bupivacaine hydrochloride 0, 1, or 2 h after CD, is unlikely to result in bupivacaine plasma concentrations reaching local anesthetic systemic toxicity thresholds in healthy patients.

The perfusion index as a method of assessing epidural anaesthesia efficacy in healthy dogs.

Introduction: Perfusion index (PI) is used as assessment of epidural anaesthesia efficacy in human medicine, but its usefulness in dogs is unknown. The aim of this study was to evaluate the usefulness of PI in determining epidural anaesthesia effectiveness. Material and Methods: This is prospective cross-over experimental study. Five healthy adult beagle dogs were anaesthetised and an epidural catheter was inserted in the lumbosacral area and adjusted so that the end of the catheter was placed at the fourth lumbar vertebra. Single-port catheters were used in the control group and multiple-port catheters were used in the treatment group. A PI probe was placed on a hind leg, and the catheter placement was confirmed via computed tomography. The treatment group received a bolus dose of lidocaine, and the control group received saline, via epidural catheter. The PI value was recorded every 5 min until 30 min after lidocaine injection. Results: The PIs of the hind limbs were not significantly different over time, nor were they between the control and lidocaine-injected groups at any point in time. Conclusion: The PI is not useful in determining the efficacy of epidural anaesthesia in dogs under general anaesthesia. In the future, finding a reliable method to evaluate the success of regional anaesthesia, even in patients under general anaesthesia, will be necessary.

Innovative Management of Opioid-Induced Hyperalgesia Using Lidocaine Infusion: A Case Report.

Prolonged opioid use carries risks, including addiction and dependence. A significant consequence of chronic opioid use is opioid-induced hyperalgesia (OIH), where patients experience heightened pain sensitivity. Managing OIH typically involves reducing opioid intake while mitigating withdrawal symptoms. This case report presents a patient with OIH treated with intravenous lidocaine and morphine. OIH presents complex pain management challenges, and lidocaine infusion has shown promise in mitigating its effects. Further research is needed to comprehensively assess the efficacy and safety of this treatment approach for patients with OIH.

Lidocaine and Dexamethasone, Ketamine and Dexamethasone, and Dexamethasone Alone in Tonsillectomy Complications.

Background: Common complications including stridor, laryngospasm, and bronchospasm are important in patients undergoing general anesthesia. Dexamethasone, lidocaine, and ketamine could have significant roles in reducing these complications. Here we aimed to compare the use of these drugs during tonsillectomy. Materials and Methods: This study was performed on 100 children that were candidates of tonsillectomy. Patients were divided into 4 groups receiving dexamethasone 0.1 mg/kg and lidocaine 1 mg/kg, ketamine 0.5 mg/kg and dexamethasone 0.1 mg/kg, dexamethasone 0.1 mg/kg, and normal saline after surgical procedures. We evaluated and compared data regarding the duration of anesthesia, oxygenation saturation, blood pressure (systolic and diastolic (SBP and DBP)), re-intubation, laryngospasm, bronchospasm, requiring analgesics after surgeries, recovery stay duration, and nausea and vomiting. Results: Administration of ketamine and dexamethasone was associated with the lowest pain and lowest need for postoperative analgesic administrations in patients (P = 0.02). Patients that received lidocaine and dexamethasone had the lowest frequencies of airway stimulations (P < 0.001). Evaluations of complications in patients revealed that stridor was significantly lower in patients that received ketamine and dexamethasone (P = 0.01). Conclusion: Usage of ketamine and dexamethasone was associated with the lowest pain severities and lowest complications. On the other hand, patients that received lidocaine and dexamethasone had the least airway stimulations.

Lidocaine-saturated cotton tip applicator used for laryngeal desensitization resulting in an iatrogenic tracheobronchial foreign body in two cats.

Case series summary: Two cats were referred to a veterinary teaching hospital with a cotton tip applicator (CTA) tracheobronchial foreign body (FB) after induction of anesthesia for an elective dental cleaning. In both cases, a lidocaine-saturated CTA, utilized to desensitize the larynx before endotracheal (ET) intubation, broke when introduced into the oropharynx and was subsequently aspirated into the tracheobronchial tree. Both CTAs were successfully removed bronchoscopically, and the cats survived with no short- or long-term complications noted. Relevance and novel information: Utilizing a lidocaine-saturated CTA to facilitate ET intubation in cats is not well described, and information on the relative risks and benefits of this specific method for laryngeal desensitization is lacking. This retrospective case series is the first to describe a complication of this technique and successful treatment. These cases highlight the risk inherent to using a CTA to desensitize the feline larynx.

Society of Family Planning Clinical Recommendation: Induction of fetal asystole before abortion Jointly developed with the Society for Maternal-Fetal Medicine☆,☆☆.

This document serves as a revision to the Society of Family Planning's 2010 guidelines, integrating literature on new techniques and research and addressing the clinical, medical, and sociolegal questions surrounding the induction of fetal asystole. Insufficient evidence exists to recommend routine induction of fetal asystole before previable medication and procedural abortion. However, at periviable gestations and after fetal viability, inducing fetal asystole before abortion prevents the infrequent but serious occurrence of unanticipated expulsion of a fetus with cardiorespiratory activity (Best Practice). Defining viability is complicated as it represents a physiological continuum impacted by gestational duration along with multiple other individual clinical factors and circumstances; therefore, the exact gestational duration to offer fetal asystole will depend on the setting and clinical circumstances. If induction of fetal asystole before abortion is available, we recommend engaging in patient-centered counseling regarding the risks and benefits of induction of fetal asystole in the setting of each unique pregnancy scenario and the patient's beliefs and priorities (Best Practice). We recommend that clinicians identify the optimal pharmacologic agent to administer for a given clinical scenario based on factors such as availability of each agent; the time frame in which fetal asystole needs to be established; and clinicians' technical ability, preferences, and practice (Best Practice). Potassium chloride, lidocaine, and digoxin are all acceptable pharmaceutical agents to induce fetal asystole before abortion. To establish asystole rapidly, we suggest the use of potassium chloride (via intracardiac or intrafunic injection) or lidocaine (via intracardiac or intrafunic injection) (GRADE 2C), although intrathoracic administration of lidocaine may be acceptable. We recommend potassium chloride not be used if intracardiac or intrafunic location cannot be achieved to avoid the risk of accidental administration to the pregnant individual and because insufficient data support its efficacy via other intrafetal locations (GRADE 1C). When using digoxin, we recommend intrafetal administration (GRADE 1C), although intraamniotic administration may be acceptable depending on a clinician's technical ability and setting. Because digoxin may take several hours to induce asystole, an alternative agent should be considered in settings where fetal asystole must be confirmed rapidly.

Anti-Allergic and Anti-Inflammatory Effects of Lidocaine-Derived Organic Compounds in a House Dust Mite-Induced Allergic Rhinitis Mouse Model.

Allergic rhinitis (AR) is a common chronic disease that significantly impacts the quality of life. Lidocaine is known to have anti-inflammatory and immunomodulatory effects. This study evaluated the effect of lidocaine analogs in a Dermatophagoides pteronyssinus (DP)-induced AR mouse model. An AR model was developed using BALB/c mice via intraperitoneal sensitization with DP and intranasal challenge with DP. One hour before stimulation with DP, lidocaine analogs, EI137 and EI341 (at a dose of 0.5 or 5 ug/g), were administered intranasally. Nasal symptoms and serum total IgE, interleukin (IL)-4, IL-10, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α levels were evaluated. Reverse-transcription polymerase chain reaction was used to determine IL-4, IL-10, and IFN-γ, as well as the expression of their mRNA transcription factors in the sinonasal mucosa. Histologic changes were evaluated using hematoxylin and eosin and periodic acid-Schiff staining. The DP-induced AR mouse model had increased serum levels of total IgE and cytokines. EI137 and EI341 significantly suppressed the levels of total IgE, IL-4, and TNF-α. Intranasal instillation of EI137 and EI341 significantly inhibited IL-4, IL-10, and IFN-γ mRNA expression, as well as inflammatory cells and mucus-producing goblet cells. Lidocaine analogs also suppressed DP-stimulated IL-4, IFN-γ, and IFN-γ production by splenocytes. Intranasal instillation of EI137 and EI341 exhibited anti-allergic and anti-inflammatory effects, influenced by Th1 and Th2 inflammatory cytokines. These lidocaine analogs suppressed DP-induced sinonasal mucosal inflammation, inflammatory cell infiltration, and mucus hypersecretion.