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Published on: September 15, 2023
In vitro effects of lidocaine hydrochloride on coronary artery bypass grafts
1Department of Cardiovascular Surgery, Namik Kemal University Medical Faculty, Tekirdag, Turkey. ozcangur@hotmail.com
Insights
High doses of lidocaine may cause vasospasm in internal mammary artery (IMA), radial artery (RA), and saphenous vein (SV) grafts used in coronary artery bypass grafting (CABG). Avoiding high lidocaine doses could improve patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Vascular Biology
Background:
- Coronary artery bypass grafting (CABG) is a common procedure to restore myocardial blood supply.
- Graft patency is influenced by graft characteristics, mechanical stress, and perioperative pharmacological agents.
- Lidocaine is a frequently used antiarrhythmic agent during the perioperative period.
Purpose of the Study:
- To investigate the in vitro effects of lidocaine on internal mammary artery (IMA), radial artery (RA), and saphenous vein (SV) grafts.
- To determine the dose-dependent responses of different graft types to lidocaine exposure.
Main Methods:
- Standard tissue bath techniques were employed to assess graft responses to varying lidocaine hydrochloride concentrations.
- Segments from 48 grafts (16 IMA, 16 RA, 16 SV) from 20 patients were studied.
- In vitro lidocaine concentrations ranged from 10(-9)M to 10(-3.5)M, simulating therapeutic plasma levels.
Main Results:
- Lidocaine induced dose-dependent vasodilatation at low concentrations (10(-9)M to 10(-7.5)M) and vasoconstriction at higher concentrations in IMA and RA grafts.
- SV grafts exhibited vasodilatation at low concentrations (10(-9)M to 10(-7)M) followed by dose-dependent vasoconstriction.
- The maximal vasoconstriction effect (Emax) was significantly higher in SV grafts (120.1±6.6%) compared to RA (83.35±5.06%) and IMA (154.0±13.8%).
Conclusions:
- Increasing perioperative lidocaine doses may induce vasospasm in IMA, RA, and SV grafts.
- High-dose lidocaine administration could potentially compromise graft patency and negatively impact perioperative and long-term mortality.
- Careful consideration of lidocaine dosage is warranted in patients undergoing CABG to optimize graft function and patient outcomes.
Aim:
Coronary artery bypass grafting (CABG) is one of the most common procedures performed to improve blood supply to myocardium. The characteristics of grafts, mechanical stress and pharmacological agents have substantial influence on the short and long term graft patency. Lidocaine is among the most frequently used antiarrhythmic agents perioperatively. The aim of this study was to evaluate the in vitro effects of lidocaine on internal mammarian artery (IMA), radial artery (RA) and saphenous vein (SV) grafts.
Methods:
Using standard tissue bath techniques, responses to increasing concentrations of lidocaine hydrochloride were obtained, in segments of IMA, RA and SV grafts. Twenty patients were enrolled in the study with a total number of 48 grafts (16 for IMA, RA and SV grafts each). In vitro lidocaine concentrations between 10(-9)M and 10(-3.5)M were studied to represent therapeutic plasma concentration of 1.5-5 mcg/mL.
Results:
In IMA and RA grafts, lidocaine hydrochloride caused vasodilatation (40.5±1.9% and 39.1±2.6 % respectively) at concentrations between 10(-9) to 10(-7.5) M while causing a dose dependent vasoconstriction response at concentrations above 10(-7.5) M. In SV graft samples, lidocain hydrochloride caused vasodilatation (24.4±1.9 %) at concentrations between 10(-9) to 10(-7) M while causing dose dependent vasoconstriction at concentrations above 10(-7) M. For vasoconstriction effect, mean±SD values for E(max) were calculated as: 120.1±6.6% in IMA, 83.35±5.06% in RA, and 154.0±13.8% in SV. The vasoconstriction in the SV samples was higher than in the RA and IMA. The mean ±SD LogEC(50) values were -5.15±0.27, -5.76±0.11 and -5.56±0.19 for SV, IMA and RA grafts respectively.) There was a statiscally significant differences in the Log EC(50) values between SV, IMA and RA (P<0.005)
Conclusion:
Based on the results of our study, we conclude that, increasing doses of lidocaine in the perioperative period may cause vasospasm in IMA, RA and SV grafts. Thus, avoiding high doses may have a role in improving perioperative and long term mortality.
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