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. 2010 Fall;57(3):104-8.
doi: 10.2344/0003-3006-57.3.104.

Effect of PaCO2 and PaO2 on lidocaine and articaine toxicity

K C Barcelos  1 , D P Furtado, J C Ramacciato, A M Cabral, D A Haas
Affiliations

Effect of PaCO2 and PaO2 on lidocaine and articaine toxicity

K C Barcelos et al. Anesth Prog. 2010 Fall.

Abstract

Alterations in arterial PaCO₂ can influence local anesthetic toxicity. The objective of this study was to evaluate the effect of stress-induced changes in PaCO₂ and PaO₂ on the seizure threshold of lidocaine and articaine. Lidocaine (2% with 1 : 100,000 epinephrine) or articaine (4% with 1 : 100,000 epinephrine) was administered intravenously under rest or stress conditions to 36 rats separated into 4 groups. Propranolol and prazosin were administered preoperatively to minimize cardiovascular effects of epinephrine. Mean arterial pressure (MAP), heart rate (HR), and arterial pH, PaCO₂, and PaO₂ were measured. Results showed no differences in MAP, HR, or pH. Stress significantly increased the latency period for the first tonic-clonic seizure induced by a toxic dose of both lidocaine and articaine (P < .05). Seizures were brought on more rapidly by articaine. No significant difference between toxic doses of lidocaine and articaine was noted. Stress raised the seizure threshold dose for both drugs and significantly (P < .01) increased arterial PaO₂ from 94.0 ± 1.90 mm Hg to 113.0 ± 2.20 mm Hg, and reduced PaCO₂ from 36.0 ± 0.77 mm Hg to 27.0 ± 0.98 mm Hg. In conclusion, reduction in PaCO₂ and/or increase in PaO₂ raised the seizure threshold of lidocaine and articaine. This study also confirmed that lidocaine and articaine have equipotent central nervous system toxicity.

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Figures

Figure 1
Figure 1
Time course (latency) between the beginning of the IV infusion of lidocaine 2% or articaine 4% and the first tonic-clonic contraction in control and stressed rats. Values represent the means ± SEM. *P < .05 when compared with the respective control group; #P < .05 versus lidocaine control; and §P < .05 versus lidocaine stressed groups. The sample size for each group is shown in parentheses.
Figure 2
Figure 2
Dose (IV infusion) of lidocaine or articaine to induce tonic-clonic seizure in controls and stressed rats. Values represent the means ± SEM. *P < .05 when compared with the respective control group. The sample size for each group is shown in parentheses.
Figure 3
Figure 3
Values of PaO2 and PaCO2 measured in the arterial blood of the stressed group before and after the stress period. **P < .01 when compared with the rest period. The sample size for each group is 18.
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