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Lidocaine pharmacokinetics in children during general anesthesia
Insights
Intravenous lidocaine pharmacokinetics in children were studied, revealing similar distribution and elimination to adults. This finding supports its safe use in pediatric patients over six months old.
Area of Science:
- Pharmacology
- Pediatric Anesthesiology
- Clinical Pharmacokinetics
Background:
- Intravenous lidocaine is increasingly used in operating rooms.
- Limited pharmacokinetic data exist for intravenous lidocaine in pediatric populations.
Purpose of the Study:
- To determine and compare the pharmacokinetics of intravenous lidocaine in children and adults.
- To establish safe dosing guidelines for pediatric anesthesia.
Main Methods:
- Ten children (0.5-3 years) and eight adults received a 1 mg/kg intravenous lidocaine infusion.
- Arterial blood samples were collected over 120 minutes and analyzed for lidocaine concentration via gas chromatography.
- Plasma concentration-time data were fitted to a two-compartment model.
Main Results:
- Children exhibited a distribution half-life (t 1/2 alpha) of 3.2 min and an elimination half-life (t 1/2 beta) of 58 min.
- Adults showed a t 1/2 alpha of 3.6 min and a t 1/2 beta of 43 min.
- No significant differences were observed in pharmacokinetic parameters (V1, Vd area, Cl) between pediatric and adult groups.
Conclusions:
- Children older than six months distribute and eliminate intravenous lidocaine similarly to adults.
- These findings suggest that current dosing regimens for adults may be applicable to pediatric patients over six months of age.
Abstract:
In spite of the increasing use of intravenous lidocaine in the operating room, no pharmacokinetic data exist for intravenous lidocaine in children. We studied ten children, ages 0.5-3 yr, and eight adults to determine lidocaine pharmacokinetics during anesthesia with halothane, nitrous oxide, and oxygen. After induction of anesthesia, tracheal intubation, and insertion of venous and arterial catheters, lidocaine, 1 mg/kg, was infused intravenously over 30 sec. Arterial samples were drawn at 0.5, 1, 2, 4, 5, 10, 15, 30, 60, 90, and 120 min. Plasma was separated and analyzed for lidocaine, using gas chromatography. Plasma concentration vs time data were fitted to a two-compartment model. Using standard formulas, we derived the following data: Children: distribution half-life (t 1/2 alpha) 3.2 min, elimination half-life (t 1/2 beta) 58 min, volume of the central compartment (V1) 0.22 L/kg, volume of distribution (Vd area) 1.1 L/kg, and total plasma clearance (Cl) 11.1 ml X kg-1 X min-1. Adults: t 1/2 alpha 3.6 min, t 1/2 beta 43 min, V1 0.16 L/kg, Vd area 0.71 L/kg, and Cl 9.8 ml X kg-1 X min-1. No significant differences were found between children and adults for all parameters analyzed. We conclude that children older than 6 months of age distribute and eliminate intravenous lidocaine in the same manner as adults.