Subcutaneous lidocaine affects inducibility in programmed electrophysiology testing in children: a follow-up study.
Invasive cardiac electrophysiology testing during cardiac catheterization requires local anesthesia at the point of entry for the catheters. Frequently, lidocaine is employed for this purpose. A prospective study completed in 1990 indicated that subcutaneous administration of lidocaine adversely influenced the inducibility of arrhythmias in pediatric patients. Upon completion of that study, lidocaine concentration was reduced from 1% to 0.5%, and extra caution was taken to avoid deep penetration during administration. A follow-up, prospective study was performed to evaluate inducibility under these changed conditions. Because the depressant effect of lidocaine on inducibility was age- and weight-related, the second study group was required to have statistically indistinguishable age and weight distributions from the first group to eliminate these variables as factors in inducibility. A total of 177 subjects were collected in the second group before a periodic random computer match with the first group produced 99 individuals with the required age and weight distributions. Analysis of the electrophysiology tests in the second study revealed that: (1) incidence of inducibility was higher in the second group (58 of 99 versus 43 of 99, p < 0.05); (2) average lidocaine dose per kilogram was lower (1.8 mg/kg versus 3.28 mg/kg, p < 0.0001); (3) average lidocaine serum concentration was also lower (0.58 micrograms/ml versus 1.47 micrograms/ml, p < 0.0003); (4) in contrast to the first study, neither lidocaine dose nor serum concentration had any effect on inducibility. We conclude that the new procedures for lidocaine administration effectively removed lidocaine as a factor in inducibility.
Buckles
D S
DS
Medical University of South Carolina, South Carolina Children's Heart Center, Charleston 29425.
Knick
B
B
Gillette
P C
PC
D000293:Adolescent; D000772:Anesthesia, Local / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000139:chemically induced / Q000503:physiopathology*; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D016002:Discriminant Analysis; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007279:Injections, Subcutaneous; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D008297:Male; D011446:Prospective Studies
D008012:Lidocaine