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(Circulation. 1971;43:205.)
© 1971 American Heart Association, Inc.

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Interrelationships of Hepatic Blood Flow, Cardiac Output, and Blood Levels of Lidocaine in Man

ROBERT E. STENSON M.D.¹; ROBERT T. CONSTANTINO M.D.¹; DONALD C. HARRISON M.D.¹

¹ From the Cardiology Division, Stanford University School of Medicine, Palo Alto, Calfornia 94305.

Factors that regulate the arterial level of lidocaine during a constant infusion were investigated in 17 patients undergoing cardiac catheterization. Lidocaine was administered by a 50 mg bolus, followed by a constant infusion of 40 µg/kg/min until steady state conditions were achieved. Cardiac output and estimated hepatic blood flow were also determined. An inverse relationship between arterial lidocaine levels and cardiac index was observed. With a low cardiac index of 1.9 ± 0.3 liters/min/m² the arterial level was 2.4 (±0.4 sem) µg/ml, while with a normal cardiac index of 3.3 ± 0.8 liters/min/m² it was 1.5 (±0.2 sem) µ/ml.

A linear relationship was also observed between estimated hepatic blood flow and cardiac index. Therefore, an inverse relationship between arterial lidocaine levels and estimated hepatic blood flow was noted. At steady-state conditions, the liver accounted for 70% (±16% sem) of the metabolism or removal of the lidocaine administered. These studies suggest that the administration of smaller doses of lidocaine will produce effective therapeutic levels when reduced hepatic blood flow exists.

Key Words: Steady-state lidocaine blood levels • Cardio-Green • Lidocaine metabolism • Hepatic metabolism and blood flow

Submitted on July 31, 1970
Accepted on October 13, 1970

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