[Slower lidocaine elimination and dose adjustment in patients with heart failure]

In 21 patients with acute coronary artery disease the influence of cardiac failure on the elimination of lidocaine (L) was evaluated by repeated serum level measurements during and after a therapeutic L-infusion. Lidocaine clearance (Cl) was less than 8 ml/min/kg in 9 of 13 cases with congestive heart failure (CHF), while in 7 out of 8 patients without CHF Cl-values were 8-12 ml/min/kg. Due to wide interindividual variability in the CHF group, however, mean values were not significantly different: 7.3 +/- 2.9 vs. 9.52 +/- 1.54 ml/min/kg (p greater than 0.05). In 3 patients receiving a simultaneous nitroglycerine infusion Cl was greater than 10 ml/min/kg despite clinical signs of CHF. The t 1/2 of L was significantly prolonged in patients with CHF: 4.29 +/- 2.14 vs. 2.43 +/- 0.58 h (p less than 0.05). It was not possible to determine individual L-dose requirements by bedside clinical examination alone. Serum level monitoring is therefore recommended in order to optimize L-therapy in patients with life-threatening arrhythmias, severe congestive heart failure and hypotension.