BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the effect of age on the pharmacokinetics of lidocaine after epidural administration. METHODS: Two percent lidocaine with epinephrine (5 microg/mL) was administered in two different age groups: an adult group (age 42 +/- 6 years, n = 10) and an elderly group (age 77 +/- 4 years, n = 10). Concentrations of lidocaine and its active metabolites, monoethylglycinexylidide (MEGX) and glycinexylidide (GX), were measured in plasma samples obtained after 15, 30, 45, 60, 90, 120, 150, and 180 minutes of administration using high-performance liquid chromatography with ultraviolet detection. RESULTS: No significant differences in plasma concentrations of lidocaine and its metabolites were observed between the two groups during the 3 hours of study. However, the elderly group showed significantly longer mean residence times (MRTs) and lower plasma clearance of lidocaine during the period compared with the adult group (P < .05). Plasma concentration ratios of MEGX/lidocaine were significantly lower in the elderly group after 2 hours of lidocaine administration (P < .05). CONCLUSIONS: The increase in plasma lidocaine concentration after epidural anesthesia in elderly patients was not as high as anticipated. However, the elderly patients showed longer MRTs, lower clearance, and lower ratios of MEGX/lidocaine than did the adult (middle-age) patients.

Adult↗

PubMedDate not supplied

The effect of head-down tilt position on arterial blood pressure after spinal anesthesia for cesarean delivery.

BACKGROUND AND OBJECTIVES: The effect of the head-down tilt position after induction of spinal anesthesia for cesarean delivery on blood pressure and level of sensory block was examined. METHODS: Patients were allocated randomly into two groups, the head-down tilt group (n = 17) and the horizontal group (n = 17). In the head-down tilt group, patients were positioned with a 10 degrees head-down tilt immediately after supine positioning, while those in the horizontal group were maintained in a horizontal position. All patients received 500 mL of lactated Ringer's solution intravenously over 10 minutes prior to spinal injection, a wedge was placed under the patient's right hip, and the operating table was rotated 5 degrees in a counterclockwise direction to provide left uterine displacement. Hypotension (defined as systolic blood pressure below 100 mm Hg) was treated with 5 mg ephedrine intravenously and an increase in the infusion rate of lactated Ringer's solution. The change in systolic blood pressure was expressed as percent change from the baseline value. RESULTS: Systolic blood pressure decreased 20% at 3 minutes after spinal block in both groups but recovered to half of this decrease. The incidence of postspinal hypotension was not different between the two groups. The total amount of ephedrine and lactated Ringer's solution administered during the first 20 minutes of spinal block did not differ between the two groups nor did the extent of the cephalad spread of analgesia 20 minutes after spinal block (T4 +/- 2 vs T4 +/- 1 for the head-down and horizontal groups, respectively). CONCLUSIONS: The head-down position is concluded to have no effect on the incidence of hypotension during spinal anesthesia for cesarean delivery.

Adult↗

PubMedDate not supplied

Plasma concentrations of lidocaine and its principal metabolites during continuous epidural infusion of lidocaine with or without epinephrine.

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the effect of epinephrine on the absorption of lidocaine and the accumulation of active metabolites of lidocaine during continuous epidural anesthesia. METHODS: Lidocaine was administered as an initial bolus of 5 mg/kg of 2% lidocaine solution followed by continuous infusion at 2.5 mg/kg/h. Patients in group I (n = 10) received lidocaine alone and patients in group II (n = 10) received lidocaine + epinephrine (5 pg/mL). Concentrations of lidocaine and its active metabolites, monoethylglycinexylidide (MEGX) and glycinexylidide (GX), were measured in plasma samples obtained after 15 minutes, 30 minutes, and 1, 2, and 3 hours of infusion using high-performance liquid chromatography with ultraviolet detection. RESULTS: Plasma lidocaine concentrations were higher in group I for the first 30 minutes; however, after 1 hour the levels were the same. Plasma MEGX and GX increased continuously in both groups. MEGX levels the were significantly higher in group I, but there was no significant difference in the sum of lidocaine + MEGX after 2 hours. There was no significant difference in GX levels between the two groups. CONCLUSIONS: With respect to continuous epidural administration, addition of epinephrine to lidocaine solutions is ineffective after 2 hours for reducing the potential for systemic toxicity, because the sum of the plasma concentrations of lidocaine and its principal active metabolite, MEGX, are unaffected.

Absorption↗

PubMedDate not supplied

A survey of ochratoxin A and aflatoxins in domestic and imported beers in Japan by immunoaffinity and liquid chromatography.

Analyses of ochratoxin A (OTA) and aflatoxins (AFs) in 94 imported beer samples from 31 producing countries and in 22 Japanese beer samples were performed by immunoaffinity column and reversed-phase liquid chromatography (LC) with fluorescence detection. Recoveries of OTA from beer samples spiked at 25 and 250 pg/mL were 86.1 and 88.2%, respectively. Recoveries of AFs were 98.4 and 98.9%, 95.4 and 95.5%, 101.2 and 97.8%, and 98.9 and 96.0%, respectively, from beer samples spiked at 4.1 and 41 pg AF B1, 4.45 and 44.5 pg AF B2, 4.7 and 47 pg AF G1, and 4.65 and 46.5 pg AF G2/mL. Detection limits were 1.0 pg/mL for OTA, 0.5 pg/mL for AFs B1 and B2, and 1.0 pg/mL for AFs G1 and G2. OTA was detected in 86 (91.5%) of 94 imported beer samples at a mean level of 10.1 pg/mL and in 21 (95.5%) of 22 Japanese beer samples at a mean level of 12.5 pg/mL. AF B1 was detected in 11 of 94 imported beer samples at a level of 0.5-83.1 pg/mL and in 2 of 22 Japanese beer samples at 0.5 and 0.8 pg/mL. Except for one beer sample from Peru, the samples contaminated with AFs were also contaminated with OTA. Although OTA was detected in most samples from various countries, AFs were detected in the beer samples from only a limited number of countries where AF contamination might be expected to occur because of their warm climate.

Aflatoxin B1↗