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Use of intravenous lidocaine to prevent reperfusion injury and subsequent multiple organ dysfunction syndrome

Authors

  • Benjamin H. Cassutto DVM,

    1. From the Lightbeacon Veterinary Services, P.O. Box 1455, Millsboro, DE 19966 (Cassutto), and Veterinary Emergency Service, Inc., 1639 North Fresno Street, Fresno, CA 93703 (Gfeller).
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  • Roger W. Gfeller DVM, DACVECC

    1. From the Lightbeacon Veterinary Services, P.O. Box 1455, Millsboro, DE 19966 (Cassutto), and Veterinary Emergency Service, Inc., 1639 North Fresno Street, Fresno, CA 93703 (Gfeller).
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Address correspondence and reprint requests to: Benjamin H. Cassutto, Lightbeacon Veterinary Services, P.O. Box 1445, Millsboro, DE 19966. E-mail: cassutto@mchsi.com

Abstract

Objective: The objective of this article is to review the human and veterinary literature and provide evidence for the potential beneficial effects of intravenous (IV) lidocaine hydrochloride in preventing post-ischemic–reperfusion injury, the systemic inflammatory response syndrome (SIRS), and subsequent multiple organ dysfunction syndrome (MODS).

Human data synthesis: Lidocaine is a local anesthetic and antiarrhythmic agent that has been used for years in human and veterinary medicine for the treatment of ventricular dysrhythmias associated with blunt cardiac trauma, myocardial ischemia, and cardiac surgery. More recently, the drug has been touted as a scavenger of reactive oxygen species (ROS), and has been used to prevent reperfusion dysrhythmias after treatment of myocardial infarction, cross-clamping of the aorta, and in trauma medicine.

Veterinary data synthesis: Although no clinical experiments with prophylactic intravenous lidocaine exist in veterinary medicine, there is a large body of evidence from experimental animals that support the use of lidocaine as a Na+/Ca2+ channel blocker, superoxide and hydroxyl radical scavenger, inflammatory modulator, and potent inhibitor of granulocyte functions. Lidocaine is being used in some clinical situations in an attempt to prevent the SIRS in veterinary trauma patients.a,b

Conclusions: A large body of experimental evidence exists supporting the use of lidocaine as an anti-oxidant and inflammatory modulator useful in preventing reperfusion injury. With the lack of cost-effective and safe treatments for reperfusion injury in veterinary and human trauma medicine, the use of IV lidocaine to prevent the ensuing inflammatory response and MODS makes it an attractive addition to existing treatments. Therefore, it is essential that prospective clinical trials involving lidocaine as a treatment for prevention of reperfusion injury be performed in companion animals to demonstrate its safety and efficacy.

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