Effects of cardiac surgery with cardiopulmonary bypass on lidocaine disposition

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Abstract
Lidocaine kinetics after cardiac surgery were studied to elucidate the effects of cardiopulmonary bypass (CPB) and major surgery on its disposition. In 5 patients lidocaine kinetics were unchanged 15 min and 1 day after CPB, but lidocaine clearance decreased 42% and volume of distribution was reduced by 40% in 8 patients 3 days after surgery. Seven days after surgery lidocaine kinetics had returned to baseline in 5 patients. These changes correlated with a doubling of the .alpha.1-acid glycoprotein concentration and a 46% decrease in lidocaine free fraction on day 3, effects that persisted on day 7. Evidently, the use of lidocaine need not be altered in the 1st day after uncomplicated coronary artery surgery, but the use of lidocaine and the interpretation of measured total lidocaine concentrations 3-7 days thereafter should be reexamined.