Lidocaine is known to be one of the most commonly used topical anesthetics. But what many people may not know is that lidocaine as an anesthetic has a lot of non-anesthetic effects, which is quite amazing. Lidocaine in addition to the anesthetic effect, it's not anesthetic effect also have a wider range of application value, has good application prospect, so is worth our further research, more widely to develop the application field of lidocaine and other local anesthetics.
The local anesthetic lidoca, due to sodium channel blocker, has the function of membrane stabilization and is applied to fight ventricular arrhythmias. In recent years, with the deepening of the pharmacological research and clinical application of lidocaine has the regulating function of the immune system and play anti-inflammatory effects in inflammatory reaction of multiple links, the significant inhibiting inflammatory reaction and acute lung injury, the sensitization effect of anti-cancer drugs, antibacterial, brain protection and reduce the postoperative cognitive dysfunction (POCD), and other aspects of the role is clinical scholar's attention.
1. Antibacterial activity of lidocaine
In 1909, it was first reported that local anesthetics had antibacterial activity. Some scholars through the study of 1200 clinical specimens of bacteria found that lidocaine on staphylococcus aureus, e. coli and other bacterial pathogens and the isolated fungi all have different degrees of inhibition, and the inhibition rate increased with the increasing of concentrations of local anesthetics, can very good prevention of hospital infection. Studies have shown that, under the clinical commonly used dosage (0.5% ~ 1.0% lidocaine and 0.125% ~ 0.25% than paid) is a significant bacteriostatic action, and with higher concentration and bacteriostasis has a tendency to increase. Moreover, 1% lidocaine has stronger bacteriostatic effect than 0.125% bupivacaine. It has been reported that lidocaine can inhibit the adhesion and chemokinesis of granulocytes and has general cytotoxicity. Studies have shown that local anesthetics inhibit the growth of escherichia coli cells, lead to the outflow of cell contents and interfere with its respiration. Combined with the above reports, it is safe and feasible to use lidocaine for epidural anesthesia or for long-term postoperative pain relief to prevent microbial growth in epidural cavity and catheter. Lidocaine local anesthetics such as antibacterial activity mechanism is not clear, may be local anesthetics and the interaction of macromolecular substances or bacterial cell surface membrane, interfere with the eukaryotes and prokaryotes cell membranes, changed the function of the cell membrane, or resulted in the death of bacteria growth inhibition.
2. Brain protection of lidocaine
Lidocaine is easy to pass the blood-brain barrier and has membrane stabilization. Under normal physiological conditions, the concentration of ions inside and outside cells is relatively constant, and abnormal ion currents can occur in brain cells in the early stages of ischemia and hypoxia. Studies have shown that lidocaine has some protective effects on brain. HouLiRen research thinks, lidocaine contract in directly to the brain and the body of large blood vessels at the same time, and expansion of brain capillaries, intracranial vascular contraction can quickly lower cranial pressure, focal area of microcirculation relieve spasm can improve the blood supply of ischemic brain tissue without "suspected of theft blood". Studies have shown that patients with supratentorial tumor resection intraoperative application of lidocaine, can reduce cerebral oxygen metabolism, reduce the anaerobic glycolysis, maintain stable blood sugar, not extend the postoperative recovery time, give play to the role of brain protection, can be safely used in craniocerebral operation. Above studies have shown that lidocaine has cerebral protective effect, its mechanism of action may by blocking Na +, K +, Ca2 + channels, reducing the intracellular Na +, Ca2 + concentration, reduce the consumption of ATP, protect nerve cells to oxygen, reduce the outflow of K + and inhibit the release of excitatory amino acids and oxygen free radicals reduce brain damage, improve cerebral blood flow, play a role of brain protection.
3. The antiarrhythmic effect of lidocaine
Lidocaine has wide - spectrum anti - arrhythmia effect. Ventricular arrhythmias including contracts before sexual period, ventricular tachycardia, ventricular fibrillation and ventricular flutter, the latter three known as malignant arrhythmia, is one of the independent risk factors of sudden cardiac death, in patients with malignant ventricular arrhythmia often result in hemodynamic deterioration, accelerate disease progression, and even life threatening. Bullish card because IB anti-arrhythmic drugs, selective effect on pu Ken wild fiber cells and ventricular muscle cells, can slow down 4 floor rate, reduce the pu Ken wild fiber self-discipline, promote the K + flight schedules and shorten the action potential, relative to extend the effective refractory period. Often used in the prevention and treatment of ventricular arrhythmia. Lidocaine can slow down cardiac conduction, inhibit cardiac contractility and reduce cardiac output. Lidocaine in clinical anti-arrhythmic use for a long time, the experience is more, in the face of ventricular arrhythmia, clinicians often choose lidocaine to control, the effectiveness and safety is higher.
4. Lidocaine can prevent excessive inflammation
Many studies have shown that lidocaine can prevent and prevent inflammation induced by trauma or endotoxin. Lidocaine stabilizer is a kind of membrane, inhibits neutrophils (PMN) adhesion, aggregation and reduce oxygen free radicals and proteolytic enzyme release, stability of cell membrane, regulating cell factors, inhibit excessive inflammation. LB4, inflammatory mediators interleukin 1 alpha (IL - 1 alpha) are strong PMN chemotaxis, induction of PMN margination, threshing, seepage, generate superoxide, and collaborative prostaglandin E2 increase vascular permeability. With mononuclear cells in vitro with different concentrations (2 ~ 20 mol/L) lidocaine can significantly inhibit LB4 incubation, IL - 1 alpha release, a mole of lidocaine concentrations can inhibit the white blood cells, mast cells, basophils release of histamine, that lidocaine can inhibit some of the key of the release of inflammatory mediators and anti-inflammatory effect. In clinical application, several studies have found that intraoperative intravenous lidocaine can regulate the immune function of patients and accelerate their postoperative recovery. Herroeder is equal to the infusion of lidocaine in patients undergoing colorectal surgery, it was found that perioperative intravenous lidocaine can accelerate the enhance the recovery of gastrointestinal function, and significantly shortened length of hospital stay, at the same time, the intravenous lidocaine can obviously decrease the plasma IL - 6, IL - 8, complement C3a, CD - 11 b expression level, such as the mechanism for lidocaine anti-inflammation regulating action of surgical trauma. Studies have reported that a prospective, randomized, double-blind, placebo-controlled, give outpatient intravenous lidocaine laparoscopic patients, found that lidocaine group of patients with postoperative recovery index increased significantly, and intravenous lidocaine can obviously shorten the hospitalization time, patients with opioid use dose also decreased significantly. There are complications such as phlebitis in the process of PCIA. The addition of lidocaine into the venous analgesic pump can effectively prevent the occurrence of phlebitis. May due to the effect of lidocaine on the vein puncture near the point of vascular endothelial cells and nerve receptors, make the blood vessels and inhibit the venous wall of trocar stimulus-response the release of inflammatory factor and vascular endothelial cells; Dilated blood vessels accelerate blood flow and prevent platelet aggregation, thereby preventing the formation of microthrombus and phlebitis. Phlebitis caused by chemotherapy is a common occurrence in clinical practice. Some studies have shown that the use of small dose of lidocaine plus dexamethasone to prevent chemotherapeutic phlebitis has a significant effect. Anyhow, perioperative small dose of lidocaine intravenous injection can reduce operation caused by inflammation, reduce the surgery, a kind of commonly used local anesthetics amide class, studies have shown that it has anti-inflammatory effects, and perioperative intravenous lidocaine can reduce postoperative pain, reduce opioid use, reduce the body's inflammatory response, speed up the patients with gastrointestinal functional recovery and shorten the length of hospital stay. Further study on the protective effect and mechanism of lidocaine on the decrease of immune function caused by surgical trauma can provide a new theoretical basis for the application of lidocaine in clinical anti-inflammatory treatment.
5. Application of lidocaine in acute lung injury
Acute lung injury (ALI) is the injury of alveolar epithelium and vascular endothelial cells caused by various pathogenic factors in and outside the lungs other than cardiogenicity, resulting from the inflammatory reaction in the lungs. Its pathogenesis is the over-uncontrolled systemic inflammatory response in the lungs. The basic pathophysiology is an uncontrolled inflammatory reaction centering on PMN infiltration and pulmonary microvascular damage. Under normal circumstances, PMN effusion, removal of necrotic tissue is a normal reaction of the body against foreign invasion, is regulated by the body's precision, inflammatory reaction is limited to local, but when serious infection, regulatory mechanism are destroyed, PMN activation is out of control, leading to inflammatory reaction to expand. Many experimental studies have confirmed that lidocaine can inhibit PMN inflammatory reaction and reduce the acute lung injury caused by various reasons. Lung injury model also found in the vein to lidocaine pretreatment compared with untreated in airway dynamics, oxygenation, pulmonary vascular permeability, histopathological changes, alveolar lavage fluid biochemical changes, etc, all have improved significantly. In brief, lidocaine can stabilize cell membrane, acting on PMN, participate in the inflammatory reaction of each link, inhibit PMN migrate to injured tissue, metabolism and endothelial cell adhesion, so as to reduce the ALI caused a variety of reasons.
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