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Local anaesthetic plasma levels in children

R L Eyres, J Kidd, R Oppenheim

    Anaesthesia and Intensive Care
    |August 1, 1978
    PubMed

    Insights

    Blood levels of lignocaine and bupivacaine in children were measured after various administrations. Peak levels in younger children after tracheal spray were below toxic adult levels, with no adverse effects observed.

    Area of Science:

    • Anesthesiology
    • Pediatric Pharmacology
    • Clinical Toxicology

    Background:

    • Lignocaine and bupivacaine are commonly used local anesthetics in pediatric procedures.
    • Understanding their pharmacokinetic profiles in children is crucial for safe administration.
    • Previous studies have indicated varying absorption rates depending on the route of administration.

    Purpose of the Study:

    • To quantify blood lignocaine and bupivacaine levels in pediatric patients following different administration routes.
    • To assess the safety of these local anesthetics in children by comparing blood concentrations to established toxic levels.
    • To identify potential risk factors, such as age, influencing anesthetic blood levels.

    Main Methods:

    • Children received caudal, subcutaneous, or tracheal administration of lignocaine and bupivacaine.
    • Serial blood samples were collected to measure drug concentrations.
    • Peak blood levels were analyzed in relation to administration route and patient age.

    Main Results:

    • Highest peak blood concentrations of lignocaine and bupivacaine were observed in children under 3 years of age following tracheal spray.
    • Despite the higher peak levels in this subgroup, all measured blood concentrations remained below the accepted toxic levels for anesthetized adults.
    • No clinical signs or symptoms of local anesthetic toxicity were observed in any of the pediatric patients.

    Conclusions:

    • Caudal, subcutaneous, and tracheal administration of lignocaine and bupivacaine appear safe in the studied pediatric population.
    • Age is a significant factor, with younger children potentially exhibiting higher peak blood levels after tracheal administration.
    • The observed blood levels suggest a wide safety margin for these anesthetics in children under typical clinical conditions.

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