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Canadian Journal of Anesthesia, Vol 32, 468-471, Copyright © 1985 by Canadian Anesthesiologists' Society

Modification of Lidocaine Protein Binding with CO2

JEFFREY L. APFELBAUM MD1, LESLIE M. SHAW PHD1, JEFFREY B. GROSS MD1, CRAIG B. CALDWELL MD1, and BARRY C. SPAULDING MD1

1 Departments of Anesthesiology and Pathology and Laboratory Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia, Pennsylvania

Address correspondence to: Dr. Jeffrey B. Gross, Department of Anesthesia (112), Veterans Administration Medical Center of Philadelphia, University and Woodland Avenues, Philadelphia, Pennsylvania 19104.

Using new, specially designed ultrafiltration devices and an enzyme immunoassay technique, the authors determined the effect of carbon dioxide tension on the fractional binding of lidocaine to human plasma proteins. Identical samples of serum at therapeutic (2.2 µg·ml-1) and toxic (6.8 µg·ml-1) lidocaine concentrations were tonometered at 37° C to CO2 tensions between 0.13 and 10.7 kPa (1.0 to 80.5 mmHg). The fraction of unbound lidocaine increased linearly with increasing pCO2 (r = 0.93, p < 0.001). These changes help to explain the increased central nervous system toxicity of lidocaine associated with hypercarbia.

Key Words: ANAESTHETICS, LOCAL: lidocaine • CARBON DIOXIDE TOXICITY: local anaesthetics






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Copyright © 1985 by the Canadian Anesthesiologists' Society.