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1.
Medicine (Baltimore) ; 98(48): e18168, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770265

RESUMO

RATIONALE: Recent years have witnessed a marked improvement in the safety and accuracy of nerve blocks with the help of ultrasound and other visualization technologies. This study reports a challenging case of a severe complication during the ultrasound-guided stellate ganglion block. PATIENT CONCERNS: A 28-year-old male patient with refractory migraine complained episodic pulsatile pain with photophobia, haphalgesia of the scalp for 3 years. INTERVENTIONS: Ultrasound-guided stellate ganglion block with 4 ml of 1% lidocaine was administrated. OUTCOMES: A sudden loss of consciousness and tonic-clonic seizure was occurred after negative aspiration and test dose. Further sonographic examination revealed a variation in the left vertebral artery, which remained unrecognized during the needle insertion because of its sliding ability under the differential pressure applied by the probe. LESSONS: Inadvertent intra-arterial injection of a local anesthetic agent could be minimized under the ultrasound guidance with various protective strategies, including the determination of any prior variation, optimizing the block route, maintaining a constant probe pressure, and using saline for the test dosage. This case resulted in the implementation of new protocols of the ultrasound-guided stellate ganglion block in our department.


Assuntos
Bloqueio Nervoso Autônomo , Complicações Intraoperatórias , Lidocaína , Convulsões , Gânglio Estrelado , Inconsciência , Artéria Vertebral , Adulto , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bloqueio Nervoso Autônomo/efeitos adversos , Bloqueio Nervoso Autônomo/métodos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Masculino , Erros Médicos/prevenção & controle , Transtornos de Enxaqueca/cirurgia , Assistência ao Paciente/métodos , Convulsões/etiologia , Convulsões/terapia , Gânglio Estrelado/diagnóstico por imagem , Gânglio Estrelado/cirurgia , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos , Inconsciência/etiologia , Inconsciência/terapia , Artéria Vertebral/anatomia & histologia , Artéria Vertebral/lesões
2.
Plast Reconstr Surg ; 144(4): 586e-596e, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568288

RESUMO

BACKGROUND: Hand rejuvenation has become increasingly popular, but there are few reports published on the use of hyaluronic acid gels for correction of volume deficits in the dorsal hand. METHODS: This study evaluated the efficacy and safety of large-gel-particle hyaluronic acid with lidocaine, a 20-mg/ml hyaluronic acid gel with 0.3% lidocaine, compared to no treatment for the correction of volume deficits in the dorsal hand. This was a prospective, multicenter, split-hand study in 90 subjects who received treatment with product in one hand. The primary efficacy endpoint was based on a 1 point of improvement with treatment versus no treatment according to the Merz Hand Grading Scale at week 12. Other assessments included Central Independent Photographic Reviewers evaluations of hand photographs, Global Aesthetic Improvement Scale, subject satisfaction, and safety. RESULTS: The mean injection volume was 2.1 ml at the first treatment. Subjects demonstrated significantly higher response rates with treatment compared to no treatment at week 12 (85.9 percent versus 21.2 percent) and at weeks 16, 20, and 24 (p < 0.0001). Photographic Reviewers assessments showed consistently greater improvements in the treated hands compared with the untreated hands from week 12 to week 24. Most subjects and investigators (≥92.8 percent) reported improvements in Global Aesthetic Improvement Scale score across all time points with treatment. Treatment-related adverse events were reported in seven subjects (7.9 percent). Most of these were mild, and none were serious. CONCLUSION: Hyaluronic acid with lidocaine is safe, effective, and well tolerated for the correction of volume deficits in the dorsal hand. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Anestésicos Locais/administração & dosagem , Técnicas Cosméticas , Mãos , Ácido Hialurônico/administração & dosagem , Lidocaína/administração & dosagem , Rejuvenescimento , Adulto , Idoso , Anestésicos Locais/efeitos adversos , Técnicas Cosméticas/efeitos adversos , Feminino , Géis , Humanos , Ácido Hialurônico/efeitos adversos , Lidocaína/efeitos adversos , Masculino , Pessoa de Meia-Idade , Tamanho da Partícula , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento
3.
Theriogenology ; 134: 83-89, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31153092

RESUMO

In equids, it is common to inject lidocaine into the testicles at the time of routine castration to provide analgesia. The effects of lidocaine on equine sperm have not been evaluated in vitro or on epididymal sperm collected following castration. The aims of this study were to determine effects of clinically relevant doses of lidocaine on equine spermatozoa in vitro using freshly collected semen and to compare the characteristics of epididymal spermatozoa after routine castration with or without intra-testicular lidocaine administration. We hypothesized that increasing concentrations of lidocaine would decrease total motility (TM), progressive motility (PM), velocity of the average path (VAP), velocity of the curved line (VCL), linearity (LIN), normal morphology (M) and membrane integrity (MI). We also hypothesized that injection of intra-testicular lidocaine would decrease TM, PM, VAP, VCL, LIN, M, and MI following routine castration, epididymal flushing and cryopreservation. In experiment 1, sperm was collected from four stallions and mixed with lidocaine at concentrations of 1 µg/ml, 10 µg/ml, 100 µg/ml, 1,000 µg/ml and 10,000 µg/ml. M and MI were compared to the control sample at 0 and 48 h. Motility parameters were analyzed at 0, 2, 4, 6, 24, and 48 h. In experiment 2, 12 stallions were castrated under general anesthesia. One testicle was removed without the use of intra-testicular lidocaine and the other testicle was removed 10 min after injection of 10 ml of 2% lidocaine. Results: In experiment 1, fresh sperm showed no significant difference (p < 0.05) compared to control at either 1 µg/ml or 10 µg/ml concentrations of lidocaine. There were significant decreases in PM, VAP, VCL, and LIN at concentrations of 100µg/ml-10,000 µg/ml and for TM at lidocaine concentrations of 1,000-10,000 µg/ml compared to control. Morphology did not change at any lidocaine concentration. Membrane integrity decreased significantly at 10,000 µg/ml lidocaine. In the second experiment 1.03 ±â€¯0.42 µg/ml lidocaine was detected in the epididymal flush of stallions treated with lidocaine. There were no significant differences in any measured parameters between the control and the lidocaine treated testicles. Intra-testicular lidocaine injection at the time of castration did not affect any measured parameters after epididymal flush. Lidocaine concentrations higher than 100 µg/ml in-vitro resulted in decreased motility parameters of the spermatozoa independent of exposure time.


Assuntos
Anestésicos Locais/efeitos adversos , Lidocaína/efeitos adversos , Análise do Sêmen/veterinária , Sêmen/efeitos dos fármacos , Espermatozoides/efeitos dos fármacos , Anestésicos Locais/uso terapêutico , Animais , Criopreservação/veterinária , Epididimo , Cavalos , Lidocaína/uso terapêutico , Masculino , Orquiectomia , Preservação do Sêmen/veterinária , Motilidade Espermática/efeitos dos fármacos , Espermatozoides/fisiologia , Testículo/efeitos dos fármacos
4.
J Vet Intern Med ; 33(4): 1585-1592, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31222803

RESUMO

BACKGROUND: Typical atrioventricular accessory pathways (APs) are composed of myocardial cells. They provide electrical connections between atria and ventricles separate from the normal conduction system. Accessory pathways can participate in a macroreentrant circuit resulting in orthodromic atrioventricular reciprocating tachycardia (OAVRT). HYPOTHESIS: Because of ultrastructural similarities of typical AP cells to ventricular myocardial cells, we hypothesized lidocaine would be effective in blocking AP conduction, thus terminating OAVRT. ANIMALS: Thirty-two consecutive client-owned dogs presenting with narrow complex tachyarrhythmias were confirmed to have OAVRT by electrophysiologic study (EPS). METHODS: Prospective, nonrandomized, single-arm study with lidocaine administered IV to dogs during OAVRT in 2 mg/kg boluses to a cumulative dose of 8 mg/kg or development of adverse effects. Electrocardiograms were monitored continuously. Subsequent EPS was performed to confirm OAVRT and the absence of other tachycardia mechanisms. RESULTS: Twenty-seven dogs experienced OAVRT cardioversion with lidocaine, before or at the time of adverse effects. Orthodromic atrioventricular reciprocating tachycardia in 5 dogs did not cardiovert before adverse effects, precluding additional dosing. Median total lidocaine dose for cardioversion was 2 mg/kg (interquartile range, 2-5.5 mg/kg). Dogs with right free wall APs had a significantly higher rate of cardioversion than did dogs with right posteroseptal APs. CONCLUSIONS AND CLINICAL IMPORTANCE: Lidocaine successfully cardioverted OAVRT in 84.4% of dogs in our study before adverse effects precluded additional dosing. In 5 dogs with dose limited by adverse effects, it is unknown whether cardioversion would have occurred at a higher cumulative dose.


Assuntos
Antiarrítmicos/farmacologia , Doenças do Cão/tratamento farmacológico , Lidocaína/farmacologia , Taquicardia Reciprocante/veterinária , Animais , Antiarrítmicos/administração & dosagem , Antiarrítmicos/efeitos adversos , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/veterinária , Cães , Feminino , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Masculino , Estudos Prospectivos , Taquicardia Reciprocante/tratamento farmacológico
5.
Dermatol Surg ; 45(10): 1294-1303, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31135570

RESUMO

BACKGROUND: VYC-25L, a hyaluronic acid soft-tissue filler with lidocaine, is designed to restore and create facial volume in the chin and jaw. OBJECTIVE: To evaluate the safety and effectiveness of VYC-25L in subjects with chin retrusion. METHODS: Adults with chin retrusion (145°-165° glabella-subnasale-pogonion facial angle) were randomized (3:1) to receive VYC-25L in the chin/jaw at study onset (treatment group) or 3 months later (control group). Primary effectiveness end point was mean change in facial angle from baseline at Month 3. Safety assessments included injection site responses (ISRs), recorded in a subject diary, and adverse events (AEs). RESULTS: VYC-25L was administered to 119 subjects (treatment group: n = 90; control group: n = 29). Mean change in facial angle from baseline at Month 3 was significantly greater in the treatment versus control group (difference: 2.51°; p < .0001). Effectiveness was also demonstrated by the proportion of subjects with improved/much improved Global Aesthetic Improvement Scale scores and responses on FACE-Q Satisfaction and Psychological Well-Being Scales. Treatment benefit remained evident at Month 12. Common ISRs were firmness (95.8%), tenderness (95.8%), and swelling (91.6%). No serious treatment-related AEs were reported. CONCLUSION: VYC-25L significantly improved glabella-subnasale-pogonion facial angle and was generally safe and well tolerated.


Assuntos
Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/administração & dosagem , Ácido Hialurônico/administração & dosagem , Lidocaína/administração & dosagem , Envelhecimento da Pele/efeitos dos fármacos , Adulto , Idoso , Queixo , Preenchedores Dérmicos/efeitos adversos , Combinação de Medicamentos , Estética , Feminino , Humanos , Ácido Hialurônico/efeitos adversos , Reação no Local da Injeção/epidemiologia , Arcada Osseodentária , Lidocaína/efeitos adversos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Resultado do Tratamento , Adulto Jovem
6.
Int J Occup Med Environ Health ; 32(3): 333-339, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-30942199

RESUMO

OBJECTIVES: Local anesthetics are some of the most common drugs used in dentistry and about 6 million people daily around the world are subjected to their effect in procedures performed by a similar number of dentists who, in turn, are usually not aware of the fact of being allergic to this group of medications. Assuming that dentists are also patients, and that in their daily practice the contact with the allergen is very frequent, it is essential to assess the incidence of allergy to lidocaine in general dental practitioners. MATERIAL AND METHODS: The authors evaluated a group of 100 general dental practitioners in whom adverse reactions similar to anaphylaxis occurred after local anesthesia. The study included individuals who, in their thorough medical history, had experienced episodes of such reactions regarding the skin, airways, gastrointestinal tract and other areas. RESULTS: The relations between type I hypersensitivity and certain symptoms, time from exposure to their appearance, as well as time from the last episode were investigated. Allergy to lidocaine was detected in 17 subjects - type I hypersensitivity was diagnosed in 13 cases (skin prick test - 7; intradermic test - 6) and 4 subjects had IgE-independent allergy (patch test). In the group where type I hypersensitivity was detected, urticaria, angioedema and rhinitis were indicated as inclusion criteria more often than among other subjects. According to the results, the occurrence of angioedema increased the risk of detection of type I hypersensitivity 68.8 times, and 1 year longer period from the last episode decreased this risk by circa 55%. CONCLUSIONS: The most important, from the clinical practice point of view, was to show the relation between the medical history indicating the anaphylactic nature of the lidocaine intolerance, and an allergy confirmed by skin tests. Int J Occup Med Environ Health. 2019;32(3):333-9.


Assuntos
Odontólogos , Hipersensibilidade/epidemiologia , Lidocaína/efeitos adversos , Doenças Profissionais/epidemiologia , Adulto , Anafilaxia/induzido quimicamente , Anafilaxia/epidemiologia , Anestésicos Locais/efeitos adversos , Angioedema/induzido quimicamente , Angioedema/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Testes do Emplastro , Testes Cutâneos
7.
Trials ; 20(1): 220, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987664

RESUMO

BACKGROUND: Pain after major head and neck cancer surgery is underestimated and has both nociceptive and neuropathic characteristics. Extended resection, flap coverage, nerve lesions, inflammation, and high-dose opioid administration can also lead to hyperalgesia and chronic postoperative pain. Opioids are frequently associated with adverse events such as dizziness, drowsiness, nausea and vomiting, or constipation disturbing postoperative recovery and extending the length of hospital stay. Patients eligible for major head and neck cancer surgery cannot benefit from full multimodal pain management with locoregional anesthesia. Intravenous lidocaine, investigated in several studies, has been found to decrease acute pain and morphine consumption. Some data suggest also that it can prevent chronic postsurgical pain. Evidence supporting its use varies between surgical procedures, and there is no published study regarding systemic lidocaine administration in major head and neck cancer surgery. We hypothesized that intravenous lidocaine infused in the perioperative period would lead to opioid sparing and chronic postsurgical pain reduction. METHODS/DESIGN: A total of 128 patients undergoing major head and neck surgery will be included in this prospective two-center, double-blind, randomized controlled trial. Patients will be randomly assigned to lidocaine or placebo treatment. After induction of general anesthesia, an intravenous lidocaine bolus will be administered (1.5 mg.kg- 1), followed by a continuous infusion (2 mg.kg- 1.h- 1) which will be reduced in the postanesthesia care unit (1 mg.kg- 1.h- 1). The primary outcome measure is morphine consumption 48 h after surgery. The secondary outcomes include intraoperative remifentanil consumption, morphine consumption 24 h after surgery, and chronic postsurgical pain that will be assessed 3-6 months after surgery. DISCUSSION: Recent evidence suggests that intravenous lidocaine can lead to opioid sparing and chronic postsurgical pain reduction for certain types of surgery. This is the first trial to prospectively investigate the efficacy and safety of intravenous lidocaine in major head and neck cancer surgery. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02894710 . Registered on 11 August 2016.


Assuntos
Anestésicos Locais/administração & dosagem , Neoplasias de Cabeça e Pescoço/cirurgia , Lidocaína/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Interpretação Estatística de Dados , Método Duplo-Cego , Humanos , Infusões Intravenosas , Lidocaína/efeitos adversos , Estudos Prospectivos
8.
JAMA ; 321(15): 1481-1490, 2019 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-30990550

RESUMO

Importance: Oral mucositis causes substantial morbidity during head and neck radiotherapy. In a randomized study, doxepin mouthwash was shown to reduce oral mucositis-related pain. A common mouthwash comprising diphenhydramine-lidocaine-antacid is also widely used. Objective: To evaluate the effect of doxepin mouthwash or diphenhydramine-lidocaine-antacid mouthwash for the treatment of oral mucositis-related pain. Design, Setting, and Participants: A phase 3 randomized trial was conducted from November 1, 2014, to May 16, 2016, at 30 US institutions and included 275 patients who underwent definitive head and neck radiotherapy, had an oral mucositis pain score of 4 points or greater (scale, 0-10), and were followed up for a maximum of 28 days. Interventions: Ninety-two patients were randomized to doxepin mouthwash (25 mg/5 mL water); 91 patients to diphenhydramine-lidocaine-antacid; and 92 patients to placebo. Main Outcome and Measures: The primary end point was total oral mucositis pain reduction (defined by the area under the curve and adjusted for baseline pain score) during the 4 hours after a single dose of doxepin mouthwash or diphenhydramine-lidocaine-antacid mouthwash compared with a single dose of placebo. The minimal clinically important difference was a 3.5-point change. The secondary end points included drowsiness, unpleasant taste, and stinging or burning. All scales ranged from 0 (best) to 10 (worst). Results: Among the 275 patients randomized (median age, 61 years; 58 [21%] women), 227 (83%) completed treatment per protocol. Mucositis pain during the first 4 hours decreased by 11.6 points in the doxepin mouthwash group, by 11.7 points in the diphenhydramine-lidocaine-antacid mouthwash group, and by 8.7 points in the placebo group. The between-group difference was 2.9 points (95% CI, 0.2-6.0; P = .02) for doxepin mouthwash vs placebo and 3.0 points (95% CI, 0.1-5.9; P = .004) for diphenhydramine-lidocaine-antacid mouthwash vs placebo. More drowsiness was reported with doxepin mouthwash vs placebo (by 1.5 points [95% CI, 0-4.0]; P = .03), unpleasant taste (by 1.5 points [95% CI, 0-3.0]; P = .002), and stinging or burning (by 4.0 points [95% CI, 2.5-5.0]; P < .001). Maximum grade 3 adverse events for the doxepin mouthwash occurred in 3 patients (4%); diphenhydramine-lidocaine-antacid mouthwash, 3 (4%); and placebo, 2 (2%). Fatigue was reported by 5 patients (6%) in the doxepin mouthwash group and no patients in the diphenhydramine-lidocaine-antacid mouthwash group. Conclusions and Relevance: Among patients undergoing head and neck radiotherapy, the use of doxepin mouthwash or diphenhydramine-lidocaine-antacid mouthwash vs placebo significantly reduced oral mucositis pain during the first 4 hours after administration; however, the effect size was less than the minimal clinically important difference. Further research is needed to assess longer-term efficacy and safety for both mouthwashes. Trial Registration: ClinicalTrials.gov Identifier: NCT02229539.


Assuntos
Antiácidos/uso terapêutico , Difenidramina/uso terapêutico , Doxepina/uso terapêutico , Neoplasias de Cabeça e Pescoço/radioterapia , Lidocaína/uso terapêutico , Antissépticos Bucais , Lesões por Radiação/tratamento farmacológico , Estomatite/tratamento farmacológico , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Difenidramina/efeitos adversos , Método Duplo-Cego , Doxepina/efeitos adversos , Fadiga/induzido quimicamente , Feminino , Humanos , Lidocaína/efeitos adversos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Estomatite/etiologia
9.
A A Pract ; 13(3): 96-98, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30920426

RESUMO

Intravenous lidocaine is increasingly being utilized as an opioid-sparing analgesic. A 55-year-old man with well-controlled human immunodeficiency virus on highly active antiretroviral therapy was prescribed a lidocaine infusion at 1 mg/kg/h for postoperative pain. On postoperative day 2, the patient experienced 4 unresponsive episodes with tachycardia, hypertension, and oxygen desaturation. Serum lidocaine level was available 2 days later (high 6.3 µg/mL, therapeutic range 2.5-3.5 µg/mL). There is significant pharmacokinetic interaction between lidocaine and this patient's human immunodeficiency virus medications. This case highlights the need for a readily accessible list of medications that caution against lidocaine. We propose in-house serum lidocaine levels to monitor patients at an increased risk for toxicity.


Assuntos
Anestésicos/efeitos adversos , Lidocaína/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Anestésicos/sangue , Anestésicos/farmacocinética , Fármacos Anti-HIV/farmacocinética , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Humanos , Infusões Intravenosas , Lidocaína/sangue , Lidocaína/farmacocinética , Masculino , Pessoa de Meia-Idade , Período Perioperatório
10.
Medicine (Baltimore) ; 98(6): e14406, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30732190

RESUMO

RATIONALE: We present a case of high spinal anesthesia after inadvertent injection of local anesthetics and corticosteroids into the subarachnoid space during attempted epidural injection. Cerebrospinal fluid (CSF) lavage is a suitable method for treatment. PATIENT CONCERNS: A 45-year-old woman presented with posterior thigh, leg, and ankle pain for >6 months and was treated with epidural injection. Five minutes after the third time of epidural injection, the patient complained loss of sensation and muscle strength in the lower extremities and abdominal area. DIAGNOSES: A high spinal anesthesia was confirmed by the patient loss of sensation and muscle strength in the lower extremities and abdominal area. INTERVENTIONS: CSF lavage was performed for treatment. OUTCOMES: After CSF lavage, the patient gradually returns to normal sensory and motor functions of lower limbs. On the fourth day, the patient sensed her physical function restoring gradually and was discharged uneventfully. At 4-month follow-up, the patient could have normal activities without obvious subsequent complications and any pain. LESSONS: We conclude that CSF lavage could be a helpful maneuver to clear lidocaine and betamethasone and avoid potential nerve damage caused by an unintentional intrathecal injection during an epidural injection for the treatment of chronic low back pain.


Assuntos
Anestesia Epidural/efeitos adversos , Dor Crônica/tratamento farmacológico , Injeções Epidurais/efeitos adversos , Dor Lombar/tratamento farmacológico , Irrigação Terapêutica/métodos , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Corticosteroides/líquido cefalorraquidiano , Anestesia Epidural/métodos , Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Anestésicos Locais/líquido cefalorraquidiano , Feminino , Humanos , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Lidocaína/líquido cefalorraquidiano , Pessoa de Meia-Idade , Espaço Subaracnóideo
11.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(2): 106-113, 2019 Feb 12.
Artigo em Chinês | MEDLINE | ID: mdl-30704182

RESUMO

Objective: This study aimed to explore a feasible method of anesthesia for painless bronchoscopy. Methods: A total of 120 patients receiving flexible bronchoscopy in Beijing Tiantan Hospital during the period from February, 8, 2018 to May, 4, 2018, were randomly divided into 3 groups, including group A (using lidocaine for local anesthesia), group B (using lidocaine + midazolam + fentanyl), and group C (using lidocaine + propofol + sufentanil). There were 41 patients in group A, 38 in group B and 41 in group C. The changes in systolic blood pressure, diastolic blood pressure, heart rate and pulse oxygen saturation(SpO(2)) in each group were recorded in different points of time. The safety of different methods of anesthesia was observed by recording vital signs and adverse events. Moreover, the visual analogue scale (VAS) was used to observe the patient's tolerance and satisfaction of the operation. Results: The intraoperative systolic blood pressure and diastolic blood pressure in group C were significantly lower than those in group A and B (P<0.05). Six cases in group C had hypotension, 3 of whom required vasoactive drugs. The differences of SpO(2) between the 3 groups showed no statistical significance (P>0.05), while patients in group C were prone to decrease in SpO(2). Eighteen patients in group C had hypoxemia during operation. But after treated with improving ventilation, the SpO(2) of those patients could be restored to normal. Compared with those in group C, patients in group A and group B showed significant discomfort, cough, and more pharyngeal pain (P<0.05). However, there were no significant differences in the degree of cough and pain between group A and group B (P>0.05). Most patients in group C had no uncomfortable sensation during the operation (P<0.05), and the willingness to re-examination was significantly higher than that in group A and group B (P<0.05). Conclusion: Propofol combined with sufentanil could achieve better painless effect, improve patient comfort and tolerance, and reduce intraoperative memory, but was prone to causing hypoxemia and hypotension. The decline of intraoperative SpO(2) could be corrected by establishing artificial airway, while the decrease of blood pressure could be corrected by applying vasoactive drugs, which were relatively safe.


Assuntos
Broncoscopia/métodos , Fentanila/uso terapêutico , Frequência Cardíaca/fisiologia , Lidocaína/uso terapêutico , Midazolam/uso terapêutico , Propofol/uso terapêutico , Sufentanil/uso terapêutico , Anestesia , Pressão Sanguínea , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Humanos , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Midazolam/administração & dosagem , Midazolam/efeitos adversos , Oximetria , Medição da Dor , Propofol/administração & dosagem , Propofol/efeitos adversos , Sufentanil/administração & dosagem , Sufentanil/efeitos adversos
12.
Tech Coloproctol ; 23(1): 15-24, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30721376

RESUMO

BACKGROUND: Return of normal gastrointestinal (GI) function is a critical determinant of recovery after colorectal surgery. The aim of this meta-analysis was to evaluate whether perioperative intravenous (IV) lidocaine benefits return of gastrointestinal function after colorectal resection. METHODS: A comprehensive search of Ovid Medline, PubMed, Embase, Cochrane library, and clinicaltrials.org was performed on 1st July 2018. A manual search of reference lists was also performed. Inclusion criteria were as follows: randomized controlled trials (RCTs) of intravenous (IV) lidocaine administered perioperatively compared to placebo (0.9% saline infusion) as part of a multimodal perioperative analgesic regimen, human adults (> 16 years), and open or laparoscopic colorectal resectional surgery. EXCLUSION CRITERIA: non-colorectal surgery, non-placebo comparator, children, non-general anaesthetic, and pharmacokinetic studies. The primary endpoint was time to first bowel movement. Secondary endpoints were time to first passage of flatus, time to toleration of diet, nausea and vomiting, ileus, pain scores, opioid analgesia consumption, and length of stay. RESULTS: One hundred and ninety one studies were screened, with 9 RCTs meeting inclusion criteria (405 patients, four laparoscopic and five open surgery studies). IV lidocaine reduced time to first bowel movement compared to placebo [seven studies, 325 patients, mean weighted difference - 9.54 h, 95% CI 18.72-0.36, p = 0.04]. Ileus, pain scores, and length of stay were reduced with IV lidocaine compared with placebo. CONCLUSIONS: Perioperative IV lidocaine may improve recovery of gastrointestinal function after colorectal surgery. Large-scale effectiveness studies to measure effect size and evaluate optimum dose/duration are warranted.


Assuntos
Anestésicos Locais/efeitos adversos , Doenças do Colo/fisiopatologia , Colonoscopia/efeitos adversos , Laparoscopia/efeitos adversos , Lidocaína/efeitos adversos , Dor Pós-Operatória/fisiopatologia , Administração Intravenosa , Adolescente , Adulto , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/administração & dosagem , Doenças do Colo/cirurgia , Colonoscopia/métodos , Defecação/efeitos dos fármacos , Feminino , Humanos , Laparoscopia/métodos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica/efeitos dos fármacos , Adulto Jovem
13.
A A Pract ; 12(11): 430-432, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-30633002

RESUMO

Local anesthetics are used throughout the health care system. In the perioperative setting and in other settings of exposure to local anesthetics, true allergy is reported very rarely. We present an unusual case of immediate-type perioperative hypersensitivity to lidocaine with cross-reaction to mepivacaine, which was missed on initial investigation. This case illustrates that lidocaine may be a "hidden allergen" in the perioperative setting and should always be considered a potential culprit in cases of suspected perioperative hypersensitivity. The case also demonstrates that suspected perioperative hypersensitivity requires highly specialized investigation and close collaboration between allergists and anesthesiologists.


Assuntos
Alérgenos/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Lidocaína/efeitos adversos , Mepivacaína/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Interações de Medicamentos , Feminino , Humanos , Pessoa de Meia-Idade , Período Perioperatório
14.
J Drugs Dermatol ; 18(1): 86-91, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30681803

RESUMO

Background: Calcium hydroxylapatite (CaHA, Radiesse®) with integral 0.3% lidocaine (CaHA(+)) has recently been approved for use in aesthetic medicine. This study assessed the performance of CaHA(+) in subjects undergoing treatment for facial volume loss and evaluated subject and physician satisfaction. Methods: In a prospective, open-label, post-marketing study, 25 women seeking treatment for age-related facial volume loss received CaHA(+) injections in 1­3 facial areas including the cheeks, marionette lines, prejowl sulcus, and jawline. Subjects returned for follow-up at 14 and 120 days, with the option of touch-up injections at day 14 if required to achieve optimal correction. Filler performance was assessed using the Merz Aesthetics Scales (MAS) and subject satisfaction using the Global Impression of Change Scale (GICS). Physician satisfaction was assessed in terms of CaHA(+)-related properties (eg, ease of injection, distribution, positioning) and aesthetic outcomes. Adverse events were recorded. Results: Mean MAS scores at baseline were ~2 corresponding to moderate facial volume loss/sagging in the treated area. At day 14, the mean score had improved to ≤1.4 for all treated areas, indicating mild volume loss. At day 120, mean scores had further improved to ≤1.1. At both follow-up visits, mean GICS scores were ≥2 indicating facial appearance was 'much improved' compared with baseline. All subjects reported willingness to repeat treatment and recommend it to family/friends. Physician ratings were high for ease of CaHA(+) injection, distribution, positioning, sculpturing outcome, and effect on skin tension. Compared to CaHA without lidocaine, the physician rated CaHA(+) as better or similar in performance. Adverse events were mostly mild and expected with CaHA and filler injections in general. Conclusion: The well-established efficacy and safety profile of CaHA appears unchanged by the addition of integral lidocaine. CaHA(+) was effective for volume enhancement in a number of facial areas and associated with high subject and physician satisfaction. J Drugs Dermatol. 2019;18(1):86-91.


Assuntos
Anestésicos Locais/uso terapêutico , Preenchedores Dérmicos/uso terapêutico , Durapatita/uso terapêutico , Dermatoses Faciais/tratamento farmacológico , Lidocaína/uso terapêutico , Satisfação do Paciente , Envelhecimento da Pele , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Anestésicos Locais/química , Preenchedores Dérmicos/administração & dosagem , Preenchedores Dérmicos/efeitos adversos , Preenchedores Dérmicos/química , Combinação de Medicamentos , Durapatita/administração & dosagem , Durapatita/efeitos adversos , Durapatita/química , Dermatoses Faciais/patologia , Feminino , Humanos , Injeções Subcutâneas , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Lidocaína/química , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento
15.
Eur J Clin Microbiol Infect Dis ; 38(6): 991-1002, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30680564

RESUMO

Local anesthetics (LAs) are medications which can provide analgesia in distinct body regions through the blockade of voltage-gated sodium channels. Besides pain management, the supplemental role of LAs as antimicrobial agents has been documented in several studies. Different databases including PubMed, Scopus, and Web of Science with the name of different local anesthetics and related names for antimicrobial keywords were searched without time limitation. This review summarized different in vitro and in vivo studies regarding antimicrobial effects of different LAs with focuses on antimicrobial applications of most studied LAs, interaction with different agents which combined with LAs, and mechanisms of action and structural dependence of LAs antibacterial effects. Among different LAs, lidocaine is the most studied preparation. Reduction of the incidence of endophthalmitis after intravitreal injection, prophylaxis for surgical wound infections, prevention of the incidence of catheter-associated infections, oral biofilm reduction on the buccal mucosa, and prevention against bacteria that produced nosocomial infection are some examples of lidocaine antimicrobial application. Studies showed that different factors including structure, concentration, duration of exposure, type of microorganism tested, and temperature affect the degree of LA antimicrobial activity. In addition, various agents such as antibiotics, preservatives, opioids, epinephrine, and propofol can combine with LAs and affect their antimicrobial properties through synergistic or antagonistic action. Due to antibacterial activities, LAs could be applied in a clinic for prophylaxis of surgical site infection. In the application of LAs prior to diagnostic procedures caution should be needed; otherwise, when culturing the specimen, they could lead to false negative results.


Assuntos
Anestésicos Locais/farmacologia , Anti-Infecciosos/farmacologia , Antibioticoprofilaxia , Anestésicos Locais/efeitos adversos , Anestésicos Locais/uso terapêutico , Animais , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/uso terapêutico , Antibioticoprofilaxia/efeitos adversos , Bactérias/efeitos dos fármacos , Interações de Medicamentos , Fungos/efeitos dos fármacos , Humanos , Controle de Infecções , Lidocaína/efeitos adversos , Lidocaína/farmacologia , Lidocaína/uso terapêutico
16.
A A Pract ; 12(11): 438-440, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-30663992

RESUMO

Local anesthetic toxicity is a rare but serious complication of local anesthetic administration. Although lidocaine has a safety profile superior to other amide local anesthetics, we report a case of cardiac arrest after intranasal injection of lidocaine. The case involves a 22-year-old healthy woman who experienced pulseless electrical activity shortly after a submucosal injection of 2.2 mg/kg of lidocaine with epinephrine. Resuscitative efforts were unsuccessful until a bolus of intralipid was given. This case emphasizes that even a "low" dose of a less lipophilic drug has the potential for severe toxicity.


Assuntos
Anestésicos Locais/administração & dosagem , Epinefrina/administração & dosagem , Parada Cardíaca/induzido quimicamente , Lidocaína/administração & dosagem , Administração Intranasal , Anestésicos Locais/efeitos adversos , Epinefrina/efeitos adversos , Emulsões Gordurosas Intravenosas/administração & dosagem , Emulsões Gordurosas Intravenosas/uso terapêutico , Feminino , Parada Cardíaca/tratamento farmacológico , Humanos , Injeções , Lidocaína/efeitos adversos , Resultado do Tratamento , Adulto Jovem
17.
Regul Toxicol Pharmacol ; 103: 34-40, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30634025

RESUMO

This study was designed to assess the preclinical toxicity of antipyrine combined with lidocaine hydrochloride ear drops (ALED) and support the clinical trials of ALED in clinical settings in China. All the experiments including acute toxicity in rodents, skin sensitization toxicity in guinea pigs, skin irritation toxicity in rabbits and chronic toxicity in rats were performed according to China Food and Drug Administration guidelines. The maximum tolerated dose (MTD) of ALED administration for mice and rats was over (400 g antipyrine plus 100 g lidocaine hydrochloride)/kg and (240 g andtipyrine plus 60 g lidocaine hydrochloride)/kg, respectively. No obvious skin sensitization toxicity and skin irritation toxicity were observed. The main changes concentrated in chronic toxicity study in rats. For the chronic toxicity, rats were administrated once a day for 28 consecutive days, and a 14-day recovery period was followed. The side effects of ALED included decreased dietary intake in male rats, increased proportion of reticulocytes, decreased or even inversed granulocyte:erythrocyte ratio, fluctuated alanine aminotransferase and aspartate aminotransferase, and slightly increased relative weight of liver. Conclusively, blood system (especially erythrocyte system) and digestive system, including liver and gastrointestinal tract, might be the toxic targets of ALED.


Assuntos
Antipirina/administração & dosagem , Antipirina/farmacologia , Orelha , Lidocaína/administração & dosagem , Lidocaína/farmacologia , Soluções Farmacêuticas/farmacologia , Animais , Antipirina/efeitos adversos , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Eritrócitos/efeitos dos fármacos , Feminino , Trato Gastrointestinal/efeitos dos fármacos , Cobaias , Lidocaína/efeitos adversos , Fígado/efeitos dos fármacos , Masculino , Camundongos , Camundongos Endogâmicos ICR , Soluções Farmacêuticas/administração & dosagem , Soluções Farmacêuticas/efeitos adversos , Coelhos , Ratos , Ratos Sprague-Dawley
18.
Anesth Analg ; 129(1): 220-225, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30320641

RESUMO

BACKGROUND: Postoperative sore throat (POST), hoarseness, and cough after tracheal intubation are not uncommon. Although both lidocaine and dexamethasone have been used independently to reduce these events, there is no study assessing the combined effects of lidocaine and dexamethasone. METHODS: This prospective, double-blind, randomized controlled study enrolled 180 patients requiring general anesthesia with endotracheal intubation for >90 minutes. They received 1 of the 4 intravenous agents just before induction of anesthesia: lidocaine (1.5 mg/kg) in group L, dexamethasone (8 mg) in group D, lidocaine (1.5 mg/kg) with dexamethasone (8 mg) in group DL, and placebo as normal saline in group NS. Standard anesthesia protocol was followed. Incidence and severity of a sore throat, cough, and hoarseness of voice were assessed up to 24 hours postoperatively. The primary outcome was the incidence of POST, and the main effects of dexamethasone and lidocaine were the primary interest. RESULTS: Data of 45 patients in D, 44 in L, 44 in DL, and 43 in NS groups were analyzed. The incidence of a sore throat was 36%, 43%, 25%, and 56% in group D, L, DL, and NS, respectively (P = .02). Dexamethasone with or without lidocaine reduced the incidence of the POST (odds ratio, 0.44; 95% confidence interval, 0.24-0.82; P < .01). However, lidocaine was not effective in reducing POST (odds ratio, 0.62; 95% confidence interval, 0.33-1.14; P = .12). No difference was observed in the severity of a sore throat, incidence and severity of a cough, and hoarseness among the groups. CONCLUSIONS: Dexamethasone, with or without lidocaine, was effective in reducing the incidence of POST in patients requiring prolonged tracheal intubation.


Assuntos
Anestésicos Locais/administração & dosagem , Dexametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Intubação Intratraqueal/efeitos adversos , Lidocaína/administração & dosagem , Faringite/prevenção & controle , Administração Intravenosa , Adulto , Anestesia Geral , Anestésicos Locais/efeitos adversos , Tosse/etiologia , Tosse/prevenção & controle , Dexametasona/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Glucocorticoides/efeitos adversos , Rouquidão/etiologia , Rouquidão/prevenção & controle , Humanos , Índia , Lidocaína/efeitos adversos , Masculino , Pessoa de Meia-Idade , Faringite/etiologia , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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