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Byline: Mamta. Dubey, Soumi. Pathak, Furkan. Ahmed Topicalisation of the airway by various techniques has routinely been recommended for awake fibre-optic bronchoscopy in cases of difficult airway. However, topicalisation by [...]

Byline: Bhavika. Singla, Anila. Malde Background and Aims: Propofol injection pain is an unresolved problem in children. Although medium and long chain triglyceride (MCT-LCT) propofol has shown promising results in [...]

Purpose Propofol injection is known to cause distressing pain, and various methods have been used to decrease this pain. We investigated the efficacy of the lidocaine + metoclopramide and lidocaine + ketamine combinations on modulating propofol injection pain. Methods Ninety ASA I/II patients aged 20-60 years were randomly assigned to three groups to receive lidocaine 20 mg (group L), lidocaine 20 mg + metoclopramide 10 mg (group LM), or lidocaine 20 mg + ketamine 5 mg (group LK), respectively, with venous occlusion for 1 min using a forearm tourniquet. Propofol 0.5 mg/kg was subsequently administered into a dorsal hand vein, and pain was assessed during its injection using a verbal rating score. The results were analyzed statistically with analysis of variance, the chi-square test, and the Wilcoxon rank sum test, where appropriate. The significance level was set at p < 0.05. Results The incidence of pain was rated to be significantly less in patients in groups LM (40 %) and LK (6.7 %) than in those in group L (83.3 %) (p = 0.001 and p < 0.001, respectively). The pain score [median (range)] was also significantly less in patients in groups LM [0 (0-3)] and LK [0 (0-2)] than in those in group L [2 (0-3)] (p = 0.001 for both groups). Conclusion The lidocaine-ketamine combination is most effective for decreasing the pain on propofol injection. Keywords Propofol injection * Pain * Lidocaine * Ketamine * Metoclopramide * Combination, Introduction Propofol is the most common intravenous induction agent used for day care and elective surgeries. However, pain during drug administration is one of the most distressing effects of propofol [...]

ABSTRACT Background: Ideally, topical anesthetics should provide rapid analgesic action without causing toxic blood levels of lidocaine or other side effects. Various formulations of lidocaine as a topical anesthetic have [...]

ABSTRACT Objectives: To determine if there is any effect on tolerance, adverse events or clinical outcome when lidocaine is added to large gel particle hyaluronic acid (LGP-HA). Materials and Methods: [...]

Sensory-selective local anesthesia has long been a key goal in local anesthetic development. For example, it allows women to be pain-free during labor without compromising their ability to push. Here we show that prolonged sensory-selective nerve block can be produced by specific concentrations of surfactant--such as are used to enhance drug flux across skin--in combination with QX-314, a lidocaine derivative that has relative difficulty penetrating nerves. For example, injection of 25 mM QX-314 in 30 mM octyl-trimethylammonium bromide (OTAB) lasted up to 7 h. Sensory selectivity was imparted to varying degrees by cationic, neutral, and anionic surfactants, and also was achieved with another lidocaine derivative, QX-222. Simultaneous injection of OTAB at a s.c. injection site remote from the sciatic nerve did not result in prolonged sensory-specific nerve blockade from QX-314, suggesting that the observed effect is due to a local interaction between the surfactant and the lidocaine derivative, not a systemic effect. analgesia | quaternary lidocaine derivative | sensory | surfactant | local anesthetics doi/10.1073/pnas.0911542107

A randomized, double-blind, crossover study to compare of the degree of pulpal anesthesia between a 4 percent articaine with 1:100,000 epinephrine and a 2 percent lidocaine with 1:100,000 epinephrine is described. It was found that successful pulpal anesthesia occurred 88% of the time with the 4% articaine while the 2% lidocaine achieved 77% success rate.

Abstract Topical anesthetic agents are frequently used by dermatologists to decrease the pain associated with a variety of cutaneous procedures, including laser surgery, soft tissue augmentation, and other cosmetic surgical [...]

Byline: T. K. Huang (1), C. F. T. Uyehara (1), V. Balaraman (2), C. Y. Miyasato (1), D. Person (1), E. Egan (3), D. Easa (1) Keywords: Surfactant; Infasurf; Lavage; Lidocaine; Pulmonary function; HCl acute lung injury Abstract: Acute respiratory distress syndrome (ARDS) is associated with significant morbidity and mortality. The pathophysiology of ARDS includes abnormalities of surfactant function as well as pulmonary inflammation. Immunomodulating drugs, like Lidocaine, have shown some success in decreasing inflammation in ARDS. We attempted to combine surfactant lavage&apos;s ability to reverse the surfactant dysfunction, while acting as a vehicle to deliver Lidocaine. Gravity-driven surfactant (Infasurf) lavage (35 ml/kg) was administered alone or mixed with Lidocaine after severe HCl acid injury (0.3 N 3 cc/kg) in neonatal piglets. Treatment groups included: control (C) (n = 5), surfactant lavage (SL) (35 ml/kg-diluted Infasurf) (n = 7) and SL mixed with Lidocaine (SL+L) (n = 7). About 26--27% of the lavage was retained (phospholipid 73--74 mg/kg Lidocaine 1.8 mg/kg). Oxygenation progressively increased in the SL and SL+L groups over the 4-hour period (at 240 min: C = 99 +- 14 SL = 154 +- 39 SL+L = 230 +- 40 mmHg) (p &lt 0.05). PaCO.sub.2 increased in all groups from 43 +- 0.3 to 55 +- 0.7 mmHg. Only SL+L showed a reduction in PaCO.sub.2 (at 240 min: C = 54 +- 4 SL = 53 +- 7 SL+L = 49 +- 2 mmHg) (p &lt 0.05). Finally, SL and SL + L had superior characteristics during the quasi-static pressure volume (PV) procedure as compared to Control (p &lt 0.05). In our HCl ALI model, SL improved oxygenation and quasi-static lung compliance over C. The pulmonary function effects of SL were further enhanced by the addition of Lidocaine to the surfactant suspension. Combining therapeutic agents with surfactant lavage may be an effective strategy in ALI. Author Affiliation: (1) Department of Clinical Investigation, Tripler Army Medical Center, TAMC, Honolulu, Hawaii 96826, USA (2) Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii and Kapiolani Medical Center, Honolulu, Hawaii 96826, USA (3) Department of Pediatrics and Physiology, University of Buffalo, State University of New York, Buffalo, New York, USA Article History: Registration Date: 01/01/2003 Accepted Date: 07/07/2003 Article note: The opinions and assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army, the Department of Defense, or the U.S. government. Presented in part at the American Thoracic Society, May 2001, San Francisco, CA, USA

Objective. Rapid achievement of dermal anesthesia in pediatric practice without discomfort is both desirable and difficult. The Northstar Iontophoretic Drug Delivery System (IDDS) is designed to achieve this objective in 10 minutes using a current of 1.78 mA, compared with the 40 to 60 minutes required for traditional percutaneous methods (eg, eutectic mixture of local anesthetics or EMLA cream). For evaluating the tolerance of this IDDS in pediatrics, 12 healthy children (5-15 years, 4 girls and 8 boys, 10 white, weight 19-79 kg) were evaluated. Methods. An open-label trial with random applications of IDDS containing lidocaine (100 mg of 10%) and epinephrine (1.05 mg of 1:10 000) to 3 of the 4 possible sites (back, chest, dorsum of hand, and antecubital fossa) was conducted. Three successive applications (time = 0, 3 hours and 3.5 hours) were performed in each subject, with repeated blood sampling (n = 12 over 10 hours) for assessment of plasma lidocaine concentrations. Skin evaluation (by Draize scoring) at both anode and cathode sites was performed at 10 and 24 hours. Results. Few of the subjects (0%-28%) experienced any dermal abnormalities at 10 hours. These findings were maintained at the 24-hour follow-up evaluation with the vast majority of subjects (92%-100%) having no evidence of erythema or edema irrespective of application site. Erythema associated with the anode seemed to be more prominent when the study device was applied to either the chest or the back as compared with the antecubital fossa or dorsum of the hand. No subjects complained of pain/discomfort associated with IDDS delivery. Plasma lidocaine levels in all subjects were below 10 ng/mL at all time points. Conclusions. The IDDS seems not to deliver a significant, systemic dose of lidocaine and to be well tolerated and potentially suitable for clinical use in pediatric subjects. Pediatrics 2003;112:578-582; iontophoresis, lidocaine, percutaneous., Venipuncture is a routine and necessary medical procedure that is performed to facilitate the care of patients and also the conduct of pediatric clinical trials that require either multiple venipunctures [...]

Arch Dis Child 2002;86:309-312 Background: Local anaesthetic creams (EMLA and Ametop) are used widely to provide pain free intravenous cannulation. However, they take a minimum of 45 minutes to become [...]

The relationship between the dose of lidocaine which is reflective of the sodium channel blockade and the defibrillation energy requirement (DER) during cardioversion is investigated using pigs as study subjects. Results reveal that the graphical relationship between lidocaine dose and DER takes the shape of an inverted U where the DER begins to fall at elevated dosages of lidocaine. The implications of these findings on cardioversion are presented.

Adhesive patches containing anesthetic may be an effective way of delivering anesthesia within the mouth before dental procedures. Researchers tested the effectiveness of 10% and 20% adhesive lidocaine patches in reducing mouth pain before needle injection in the mouths of 100 patients. Patients receiving either the 10% or 20% concentration lidocaine patches reported less pain from needlesticks than patients receiving placebo patches, and anesthesia was perceived 2.5 to 5 minutes after patch placement. No drug reactions were observed.

Head trauma leading to concussion and electroconvulsive shock (ECS) in humans causes amnesia for events that occurred shortly before the injury (retrograde amnesia). The present experiment investigated the amnesic effect of lidocaine and ECS in 25 rats trained on a working memory version of the Morris water task. Each day, the escape platform was moved to a new location; learning was evidenced by a decrease in the latency to find the platform from the first to the second trial. 'Consolidation' of this newly encoded spatial engram was disrupted by bilateral inactivation of the dorsal hippocampus with 1 [[micro]liter] of 4% lidocaine applied as soon as possible after the first trial. When trial 2 was given after recovery from the lidocaine (30 min after the injection), a normal decrease in latency indicated that the new engram was not disrupted. When trial 2 was given under the influence of lidocaine (5 min after injection), absence of latency decrease demonstrated both the success of the inactivation and the importance of hippocampus for the task. To examine the role of events immediately after learning, ECS (30 or 100 mA, 50 Hz, 1.2 sec) was applied 0 sec to 45 sec after a single escape to the new platform location. A 2-h delay between ECS and trial 2 allowed the effects of ECS to dissipate. ECS applied 45 sec or 30 sec after trial 1 caused no retrograde amnesia: escape latencies on trial 2 were the same as in control rats. However, ECS applied 0 sec or 15 sec after trial 1 induced clear retrograde amnesia: escape latencies on trial 2 were no shorter than on trial 1. It is concluded that the consolidation of a newly formed memory for spatial location can only be disrupted by ECS within 30 sec after learning.

ABSTRACT Although the cosmetic applications of injectable calcium hydroxylapatite (CaHA) commenced in the first years of the 21st century, only recently has the clinical use of this filler been optimized. [...]

Varicella-zoster virus is the cause of both chickenpox and herpes zoster. In the case of zoster, the virus has established a latent infection in a sensory ganglion. (A sensory ganglion is a cluster of nerve cells outside the central nervous system.) Once this latent infection is established, it is never eliminated. From time to time, the infection becomes reactivated and the skin area served by the infected nerve develops a severe painful rash. The rash resolves and most patients are then fine until the next bout with the recalcitrant virus. A minority of patients, perhaps 10 percent, continue to experience persistent pain after the rash has healed. This condition, called postherpetic neuralgia, is more common among the elderly, and it is thought that more than half of all patients over 60 who suffer from herpes zoster develop postherpetic neuralgia. The pain of postherpetic neuralgia can be incapacitating in its severity and may persist for years. In some patients it never stops. Only the tricyclic antidepressant drugs have proved effective in the alleviation of this pain, but the side effects of these drugs render them unsatisfactory for many patients. Furthermore, for many patients they simply do not work, and no pain relief is achieved. A study was conducted to evaluate the effectiveness of morphine and lidocaine in the treatment of postherpetic neuralgia in 19 patients. Both drugs were administered intravenously during the trials, although lidocaine is more commonly used as a local anesthetic. Ten patients reported morphine to produce the best pain relief, while four said lidocaine was more effective. The remainder experienced no relief or said the saline placebo was best. The patients who reported pain relief also reported that their allodynia had disappeared. (Allodynia is a condition in which a normally painless stimulus is perceived as painful.) The results indicate that both morphine and lidocaine may be useful in the treatment of postherpetic neuralgia. (Consumer Summary produced by Reliance Medical Information, Inc.)