Chest
Volume 117, Issue 4, April 2000, Pages 1055-1060
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Clinical Investigations
BRONCHOSCOPY
Serum Lidocaine Concentrations in Asthmatics Undergoing Research Bronchoscopy

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Study objectives

To determine how often serum lidocaine concentrations (SLC) fall into the potentially toxic range (> 5 mg/L) in asthmatics undergoing research bronchoscopy, and to determine whether subject or procedure characteristics are associated with higher SLC.

Design

Prospective, observational study.

Setting

Academic research center.

Participants

Fifty-one volunteers with mild to moderate asthma enrolled in three separate bronchoscopy protocols to study airway inflammation in asthma.

Interventions

Lidocaine was administered topically to the upper airway and tracheobronchial tree to achieve local anesthesia for bronchoscopy. Venous blood was sampled during bronchoscopy, 30 min after upper airway anesthesia was completed (time 1), and 30 min after bronchoscopy was completed (time 2).

Measurements and results

The mean total amount of lidocaine administered was 600 ± 122 mg (8.2 ± 2.0 mg/kg). No signs or symptoms of lidocaine toxicity were observed in any of the subjects. SLC ranged between 0.10 and 2.90 mg/L at time 1 and 0.50 and 3.20 mg/L at time 2. SLC was significantly correlated with the total amount of lidocaine (milligrams/kilogram) administered at both points (time 1, r = 0.33, p = 0.021; time 2, r = 0.33, p = 0.023). No statistically significant relationship was observed between SLC and subject age, sex, weight, baseline FEV1, procedure length, or study protocol. No statistically significant relationship was found between subject FEV1 and either total lidocaine dose or procedure length.

Conclusions

An average total dose of 600 mg (8.2 mg/kg) of lidocaine appears to be safe in mild to moderate asthmatics undergoing research bronchoscopy.

Section snippets

Subjects

Fifty-one asthmatic volunteers ranging in age from 19 to 62 years (33.5 ± 9.6 years; mean ± SD) were recruited from the general Denver community. All subjects met diagnostic criteria for asthma.11 Exclusion criteria included any history of significant nonasthmatic pulmonary disease, significant nonpulmonary disease (including cardiac, liver, or kidney disease), pregnancy, and any history of tobacco use during the past 1 year or > 5 pack-years of total use. All subjects gave informed consent to

Clinical Evidence of Lidocaine Toxicity

Among the 51 subjects who underwent bronchoscopy, there were no observed signs or symptoms of CNS, cardiac, or respiratory lidocaine toxicity, nor were there any significant adverse events reported during the 24 h after the procedure.

Amount of Lidocaine Administered

The mean total amount of lidocaine administered, as calculated by adding the amount of 4% and 1% lidocaine given to the subject for the entire procedure, was 600 ± 122 mg. The total amount of lidocaine administered ranged between 320 and 880 mg. Expressed per

Discussion

In this group of young, otherwise healthy volunteers with mild to moderate asthma, SLC measured during bronchoscopy, 30 min after upper airway anesthesia, and 30 min after bronchoscopy did not fall into the potentially toxic range (≥ 5 mg/L) for any of the subjects. This was true even though the average total amount of lidocaine administered, 600 ± 122 mg, exceeded the 400-mg total dose limit previously recommended for investigative bronchoscopy.1 None of the subjects displayed signs or

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Cited by (0)

Supported by NHLBI grants HL36577 (Drs. Kraft and Martin) and HL03343 (Dr. Kraft), and the American Lung Association Asthma Research Center Award (Drs. Kraft and Martin).

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