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Kardiologia Polska Oct 2020Appropriate pharmacotherapy during advanced resuscitation procedures may affect the return of spontaneous circulation. Current guidelines on cardiopulmonary... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Appropriate pharmacotherapy during advanced resuscitation procedures may affect the return of spontaneous circulation. Current guidelines on cardiopulmonary resuscitation recommend amiodarone for shock‑refractory cardiac arrest or when lidocaine is not available.
AIMS
The aim of this study was to systematically analyze the available literature and to conduct a meta‑‑analysis to determine the effect of amiodarone and lidocaine on survival and neurological outcome after shock‑refractory cardiac arrest.
METHODS
PubMed, Scopus, Embase, Web of Science, and Cochrane Library databases were searched. Two independent reviewers screened randomized and quasi‑randomized controlled trials as well as cohort and cross‑sectional trials evaluating amiodarone or lidocaine for the treatment of adults with cardiac arrest.
RESULTS
After screening 682 unique references, 8 were selected for this meta‑analysis. A higher number of cases with return of spontaneous circulation was observed in the amiodarone group compared with the lidocaine group (OR, 1.03; 95% CI, 0.87-1.21; P = 0.75). A similar relationship was observed for survival to hospital discharge (OR, 1.12; 95% CI, 0.92-1.38; P = 0.26), as well as survival with favorable neurological outcome (OR, 1.11; 95% CI, 0.89-1.39; P = 0.35).
CONCLUSIONS
We found no statistically significant survival benefit of resuscitation with amiodarone compared with lidocaine. Future randomized controlled trials are needed to identify which antiarrhythmic drug should be use in shock‑refractory cardiac arrest.
Topics: Amiodarone; Anti-Arrhythmia Agents; Cardiopulmonary Resuscitation; Cross-Sectional Studies; Humans; Lidocaine; Out-of-Hospital Cardiac Arrest
PubMed: 32627999
DOI: 10.33963/KP.15483 -
Anaesthesia Apr 1958
Topics: Analgesia; Anesthesia; Anesthesia and Analgesia; Anesthesia, Intravenous; Humans; Lidocaine; Pain
PubMed: 13521304
DOI: 10.1111/j.1365-2044.1958.tb08045.x -
Clinical Pharmacology in Drug... Jan 2017Lidocaine vaginal bioadhesive gel is being developed as a local anesthetic for use in minimally invasive outpatient gynecological procedures and was investigated in... (Randomized Controlled Trial)
Randomized Controlled Trial
Lidocaine vaginal bioadhesive gel is being developed as a local anesthetic for use in minimally invasive outpatient gynecological procedures and was investigated in single-dose and multiple-dose studies in healthy young adult women. Lidocaine doses of 2.5%, 5%, and 10% (w/w) were administered, and parent drug and metabolites monoethylglycinexylidide and glycinexylidide were measured in plasma. Lidocaine was absorbed through vaginal tissue and into the systemic circulation in a dose-proportional manner, and there was little systemic accumulation. Plasma concentrations were 10- to 20-fold lower than concentrations obtained after administration of intravenous lidocaine used to treat arrhythmic activity, thus demonstrating a wide safety margin for a vaginal lidocaine product.
Topics: Administration, Intravaginal; Adult; Anesthetics, Local; Dose-Response Relationship, Drug; Double-Blind Method; Female; Healthy Volunteers; Humans; Lidocaine; Young Adult
PubMed: 27297519
DOI: 10.1002/cpdd.286 -
Anaesthesia Apr 1964
Topics: History; Lidocaine
PubMed: 14150670
DOI: 10.1111/j.1365-2044.1964.tb00363.x -
Academic Emergency Medicine : Official... Sep 1997Intravenous lidocaine has the potential to control seizures. This article reviews the available evidence related to lidocaine's efficacy and clarifies its potential role... (Review)
Review
Intravenous lidocaine has the potential to control seizures. This article reviews the available evidence related to lidocaine's efficacy and clarifies its potential role in the management of status epilepticus (SE). Although there are no large, double-blind, placebo-controlled studies of lidocaine's efficacy in SE, numerous case reports and case series support its use. Most of the reported cases involve patients who were refractory to multiple antiseizure medications. Additional support for lidocaine's efficacy in SE comes from the pediatric literature, where lidocaine has been very effective in controlling SE in neonates who have not responded to barbiturates. Initial lidocaine doses used to stop seizures have ranged from 1 to 3 mg/kg. Most reports recommend a maintenance infusion of lidocaine after initial termination of SE, and a continuous infusion is almost universally recommended for neonates. Toxicity from a 1.5-2.0 mg/kg dose of lidocaine for the control of SE is rare; the authors found only 1 case of a possible side effect at that dose. The article provides a 5-step approach to treating SE that includes lidocaine.
Topics: Clinical Trials as Topic; Drug Administration Schedule; Humans; Infusions, Intravenous; Injections, Intravenous; Lidocaine; Status Epilepticus; Treatment Outcome
PubMed: 9305436
DOI: 10.1111/j.1553-2712.1997.tb03820.x -
Journal of Obstetrics and Gynaecology... Oct 2016To evaluate the physical compatibility and chemical stability of mixtures of magnesium sulphate and lidocaine in order to determine the feasibility of manufacturing a...
OBJECTIVE
To evaluate the physical compatibility and chemical stability of mixtures of magnesium sulphate and lidocaine in order to determine the feasibility of manufacturing a prefilled syringe combining these two drugs for use as an intramuscular (IM) loading dose for eclampsia prevention and/or treatment. This ready-to-use mixture will provide a more tolerable and accessible route of administration appropriate for widespread use.
METHODS
Physical compatibility (pH, colour, and formation of precipitate) and chemical stability (maintaining > 90% of initial concentrations) of mixtures of MgSO, using both commercially available MgSO (50%) and MgSO reconstituted from salt (61%), with lidocaine hydrochloride (2%) were evaluated every 14 days over six months. The concentration of lidocaine was determined by a stability indicating high performance liquid chromatographic method, while the concentration of magnesium was determined by an automated chemistry analyzer.
RESULTS
No changes in pH, color or precipitates were observed for up to 6 months. The 95% confidence interval of the slope of the curve relating concentration to time, determined by linear regression, indicated that only the admixtures of commercially-available magnesium sulfate and lidocaine as well as the 61% magnesium sulfate solution (reconstituted from salt) maintained at least 90% of the initial concentration of both drugs at 25°C and 40°C at 6 months.
CONCLUSIONS
Commercially available MgSO4 and lidocaine hydrochloride, when combined, are stable in a pre-filled syringe for at least six months in high heat and humidity conditions. This finding represents the first step in improving the administration of magnesium sulphate in the treatment and prevention of eclampsia in under-resourced settings.
Topics: Drug Stability; Hot Temperature; Lidocaine; Magnesium Sulfate; Syringes
PubMed: 27720093
DOI: 10.1016/j.jogc.2016.04.097 -
British Journal of Pharmacology May 2022Sudden cardiac death (SCD) caused by acute myocardial ischaemia and ventricular fibrillation (VF) is an unmet therapeutic need. Lidocaine suppresses ischaemia-induced...
BACKGROUND AND PURPOSE
Sudden cardiac death (SCD) caused by acute myocardial ischaemia and ventricular fibrillation (VF) is an unmet therapeutic need. Lidocaine suppresses ischaemia-induced VF, but its utility is limited by side effects and a narrow therapeutic index. Here, we characterise OCT2013, a putative ischaemia-activated prodrug of lidocaine.
EXPERIMENTAL APPROACH
The rat Langendorff-perfused isolated heart, anaesthetised rat and rat ventricular myocyte preparations were utilised in a series of blinded and randomised studies to investigate the antiarrhythmic effectiveness, adverse effects and mechanism of action of OCT2013, compared with lidocaine.
KEY RESULTS
In isolated hearts, OCT2013 and lidocaine prevented ischaemia-induced VF equi-effectively, but OCT2013 did not share lidocaine's adverse effects (PR widening, bradycardia and negative inotropy). In anaesthetised rats, i.v. OCT2013 and lidocaine suppressed VF and increased survival equi-effectively; OCT2013 had no effect on cardiac output even at 64 mg·kg i.v., whereas lidocaine reduced it even at 1 mg·kg . In adult rat ventricular myocytes, OCT2013 had no effect on Ca handling, whereas lidocaine impaired it. In paced isolated hearts, lidocaine caused rate-dependent conduction slowing and block, whereas OCT2013 was inactive. However, during regional ischaemia, OCT2013 and lidocaine equi-effectively hastened conduction block. Chromatography and MS analysis revealed that OCT2013, detectable in normoxic OCT2013-perfused hearts, became undetectable during global ischaemia, with lidocaine becoming detectable.
CONCLUSIONS AND IMPLICATIONS
OCT2013 is inactive but is bio-reduced locally in ischaemic myocardium to lidocaine, acting as an ischaemia-activated and ischaemia-selective antiarrhythmic prodrug with a large therapeutic index, mimicking lidocaine's benefit without adversity.
Topics: Animals; Anti-Arrhythmia Agents; Ischemia; Lidocaine; Myocardial Ischemia; Prodrugs; Rats; Rats, Wistar; Ventricular Fibrillation
PubMed: 34855992
DOI: 10.1111/bph.15764 -
Journal of Chromatographic Science Apr 2016Two sensitive and selective analytical methods were developed for simultaneous determination of aminoacridine hydrochloride and lidocaine hydrochloride in bulk powder...
Two sensitive and selective analytical methods were developed for simultaneous determination of aminoacridine hydrochloride and lidocaine hydrochloride in bulk powder and pharmaceutical formulation. Method A was based on HPLC separation of the cited drugs with determination of the toxic lidocaine-related impurity 2,6-dimethylaniline. The separation was achieved using reversed-phase column C18, 250 × 4.6 mm, 5 µm particle size and mobile phase consisting of 0.05 M disodium hydrogen phosphate dihydrate (pH 6.0 ± 0.2 adjusted with phosphoric acid) and acetonitrile (55 : 45, v/v). Quantitation was achieved with UV detection at 240 nm. Linear calibration curve was in the range of 1.00-10.00, 13.20-132.00 and 1.32-13.20 µg mL(-1) for aminoacridine hydrochloride, lidocaine hydrochloride and 2,6-dimethylaniline, respectively. Method B was based on TLC separation of the cited drugs followed by densitometric measurement at 365 nm on the fluorescent mode for aminoacridine hydrochloride and 220 nm on the absorption mode for lidocaine hydrochloride. The separation was carried out using ethyl acetate-methanol-acetic acid (65 : 30 : 5 by volume) as a developing system. The calibration curve was in the range of 25.00-250.00 ng spot(-1) and 0.99-9.90 µg spot(-1) for aminoacridine hydrochloride and lidocaine hydrochloride, respectively. The results obtained were statistically analyzed and compared with those obtained by applying the manufacturer's method.
Topics: Administration, Oral; Aminacrine; Chromatography, High Pressure Liquid; Drug Contamination; Gels; Lidocaine; Pharmaceutical Preparations
PubMed: 26671412
DOI: 10.1093/chromsci/bmv170 -
Anesthesiology May 1979The pharmacokinetics of lidocaine were studied in fetal and neonatal lambs and in pregnant and nonpregnant adult sheep. Catheters were implanted in the femoral vessels...
The pharmacokinetics of lidocaine were studied in fetal and neonatal lambs and in pregnant and nonpregnant adult sheep. Catheters were implanted in the femoral vessels and in the urinary bladders of animals prepared for chronic study. Lidocaine, 5--10 mg/kg, was injected intravenously either into the fetus or newborn lamb or into nonpregnant adult sheep. Serial samples of arterial blood and urine were obtained over four hours and analyzed for unchanged lidocaine using a gas chromatographic technique. The elimination half-lives of lidocaine in the bloods of nonpregnant ewe, neonate and fetus were 31, 51 and 33 min, respectively. Total-body clearances in the neonate and adult were 53 and 41 ml/min/kg. The metabolic clearances of lidocaine were the same in both, and approximated hepatic blood flow. Renal clearance was greater in the neonate, which was attributed to differences in urinary pH values and extents of protein binding. Thus, despite differences in half-lives, the newborn lamb is as capable as the adult of clearing lidocaine.
Topics: Age Factors; Animals; Animals, Newborn; Female; Fetus; Kinetics; Lidocaine; Metabolic Clearance Rate; Pregnancy; Sheep
PubMed: 453562
DOI: 10.1097/00000542-197905000-00011 -
Journal of Translational Medicine Oct 2022Transcatheter arterial embolization (TAE) is one of the first-line treatments for advanced hepatocellular cancer. The pain caused by TAE is a stark complication, which...
BACKGROUND
Transcatheter arterial embolization (TAE) is one of the first-line treatments for advanced hepatocellular cancer. The pain caused by TAE is a stark complication, which remains to be prevented by biomedical engineering methods.
METHODS
Herein, a commercial embolic agent CalliSpheres bead (CB) was functionally modified with lidocaine (Lid) using an electrostatic self-assembly technique. The products were coded as CB/Lid-n (n = 0, 5, 10, corresponding to the relative content of Lid). The chemical compositions, morphology, drug-loading, and drug-releasing ability of CB/Lid-n were comprehensively investigated. The biocompatibility was determined by hemolysis assay, live/dead cell staining assay, CCK8 assay, immunofluorescence (IHC) staining assay and quantitative real-time PCR. The thermal withdrawal latency (TWL) and edema ratio (ER) were performed to evaluate the analgesia of CB/Lid-n using a plantar inflammation model. A series of histological staining, including immunohistochemistry (IL-6, IL-10, TGF-β and Navi1.7) and TUNEL were conducted to reveal the underlying mechanism of anti-tumor effect of CB/Lid-n on a VX2-tumor bearing model.
RESULTS
Lid was successfully loaded onto the surface of CalliSpheres bead, and the average diameter of CalliSpheres bead increased along with the dosage of Lid. CB/Lid-n exhibited desirable drug-loading ratio, drug-embedding ratio, and sustained drug-release capability. CB/Lid-n had mild toxicity towards L929 cells, while triggered no obvious hemolysis. Furthermore, CB/Lid-n could improve the carrageenan-induced inflammation response micro-environment in vivo and in vitro. We found that CB/Lid-10 could selectively kill tumor by blocking blood supply, inhibiting cell proliferation, and promoting cell apoptosis. CB/Lid-10 could also release Lid to relieve post-operative pain, mainly by remodeling the harsh inflammation micro-environment (IME).
CONCLUSIONS
In summary, CB/Lid-10 has relatively good biocompatibility and bioactivity, and it can serve as a promising candidate for painless transcatheter arterial embolization.
Topics: Carrageenan; Embolization, Therapeutic; Hemolysis; Humans; Inflammation; Interleukin-10; Interleukin-6; Lidocaine; Transforming Growth Factor beta
PubMed: 36221084
DOI: 10.1186/s12967-022-03653-8