Protective effect of lidocaine in acute cerebral ischemia induced by air embolism

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  • 1 Hyperbaric Medicine Program Center, Naval Medical Research Institute, Bethesda, Maryland, and Department of Neurological Surgery, George Washington University Medical Center, Washington, D.C.
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✓ To investigate possible approaches to the prevention and treatment of neural damage induced by air embolism and other forms of acute cerebral ischemia, a model was used in which cerebral air embolism was produced by infusion of air (0.4 ml) into a vertebral artery of chloralose-anesthetized cats. Neurological function was assessed by measuring cortical somatosensory evoked responses in a group of 10 untreated animals and in a group of eight animals pretreated with intravenous lidocaine (5 mg/kg). In the untreated group, the primary somatosensory amplitude was reduced to 28% ± 9% (mean ± standard error) of the value before air embolism, with a return to 60% ± 8% 1 hour and 73% ± 12% 2 hours after embolism. In the group pretreated with lidocaine, the primary somatosensory amplitude was reduced to 68% ± 9% of the value before air embolism, with a return to 92% ± 3% 1 hour and 97 ± 2% 2 hours after embolism. Pretreatment with lidocaine also greatly attenuated the acute hypertension and the increase in intracranial pressure following air embolism. These results demonstrate that pretreatment with intravenous lidocaine significantly reduces the neural decrement and increases the recovery of neural function after acute cerebral ischemia induced by air embolism.

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Contributor Notes

Address reprint requests to: Delbert E. Evans, Ph.D., Naval Medical Research and Development Command, Naval Medical Command, National Capital Region, Bethesda, Maryland 20814.
  • 1.

    Astrup J: Energy-requiring cell functions in the ischemic brain. Their critical supply and possible inhibition in protective therapy. J Neurosurg 56:482497, 1982 Astrup J: Energy-requiring cell functions in the ischemic brain. Their critical supply and possible inhibition in protective therapy. J Neurosurg 56:482–497, 1982

    • Search Google Scholar
    • Export Citation
  • 2.

    Astrup J, , Skovsted P, & Gjerris F, et al: Increase in extracellular potassium in the brain during circulatory arrest: effects of hypothermia, lidocaine, and thiopental. Anesthesiology 55:256262, 1981 Astrup J, Skovsted P, Gjerris F, et al: Increase in extracellular potassium in the brain during circulatory arrest: effects of hypothermia, lidocaine, and thiopental. Anesthesiology 55:256–262, 1981

    • Search Google Scholar
    • Export Citation
  • 3.

    Astrup J, & Sørensen HR: Inhibition of cerebral metabolism by lidocaine. Eur Neurol 20:221224, 1981 Astrup J, Sørensen HR: Inhibition of cerebral metabolism by lidocaine. Eur Neurol 20:221–224, 1981

    • Search Google Scholar
    • Export Citation
  • 4.

    Astrup J, , Sørensen PM, & Sørensen HR: Inhibition of cerebral oxygen and glucose consumption in the dog by hypothermia, pentobarbital, and lidocaine. Anesthesiology 55:263268, 1981 Astrup J, Sørensen PM, Sørensen HR: Inhibition of cerebral oxygen and glucose consumption in the dog by hypothermia, pentobarbital, and lidocaine. Anesthesiology 55:263–268, 1981

    • Search Google Scholar
    • Export Citation
  • 5.

    Astrup J, , Sørensen PM, & Sørensen HR: Oxygen and glucose consumption related to Na+-K+ transport in canine brain. Stroke 12:726730, 1981 Astrup J, Sørensen PM, Sørensen HR: Oxygen and glucose consumption related to Na+-K+ transport in canine brain. Stroke 12:726–730, 1981

    • Search Google Scholar
    • Export Citation
  • 6.

    Bailey RC, & Homer LD: Iterative parameter estimation. Naval Medical Research Institute Report 76-11 116, 1976 Bailey RC, Homer LD: Iterative parameter estimation. Naval Medical Research Institute Report 76-11:1–16, 1976

    • Search Google Scholar
    • Export Citation
  • 7.

    Branston NM, , Symon L, & Crockard HA: Recovery of the cortical evoked response following temporary middle cerebral artery occlusion in baboons: relation to local blood flow and PO2. Stroke 7:151157, 1976 Branston NM, Symon L, Crockard HA: Recovery of the cortical evoked response following temporary middle cerebral artery occlusion in baboons: relation to local blood flow and PO2. Stroke 7:151–157, 1976

    • Search Google Scholar
    • Export Citation
  • 8.

    Branston NM, , Symon L, & Crockard HA, et al: Relationship between the cortical evoked potential and local cortical blood flow following acute middle cerebral artery occlusion in the baboon. Exp Neurol 45:195208, 1974 Branston NM, Symon L, Crockard HA, et al: Relationship between the cortical evoked potential and local cortical blood flow following acute middle cerebral artery occlusion in the baboon. Exp Neurol 45:195–208, 1974

    • Search Google Scholar
    • Export Citation
  • 9.

    Cracco RQ: The initial positive potential of the human scalp recorded somatosensory evoked response. Electroencephalogr Clin Neurophysiol 32:623629, 1972 Cracco RQ: The initial positive potential of the human scalp recorded somatosensory evoked response. Electroencephalogr Clin Neurophysiol 32:623–629, 1972

    • Search Google Scholar
    • Export Citation
  • 10.

    Evans DE, , Kobrine AI, & Bradley ME: Protective effect of lidocaine against the decrement in neurological function caused by cerebral air embolism. Fed Proc 40:324, 1981 (Abstract) Evans DE, Kobrine AI, Bradley ME: Protective effect of lidocaine against the decrement in neurological function caused by cerebral air embolism. Fed Proc 40:324, 1981 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 11.

    Evans DE, , Kobrine AI, & Flynn ET, et al: Treatment of cardiovascular dysfunction resulting from cerebral air embolism, in Bachrach AJ (ed): Seventh Symposium on Underwater Physiology. Bethesda, Md: Undersea Medical Society, 1980, p 14 (Abstract) Evans DE, Kobrine AI, Flynn ET, et al: Treatment of cardiovascular dysfunction resulting from cerebral air embolism, in Bachrach AJ (ed): Seventh Symposium on Underwater Physiology. Bethesda, Md: Undersea Medical Society, 1980, p 14 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 12.

    Evans DE, , Kobrine AI, & Weathersby PK, et al: Cardiovascular effects of cerebral air embolism. Stroke 12:338344, 1981 Evans DE, Kobrine AI, Weathersby PK, et al: Cardiovascular effects of cerebral air embolism. Stroke 12:338–344, 1981

    • Search Google Scholar
    • Export Citation
  • 13.

    Evans DE, , Weihl AC, & David TD, et al: Effects of cerebral air embolism on circulating catecholamines and angiotensin. Undersea Biomed Res 6 (Suppl 1):30, 1979 Evans DE, Weihl AC, David TD, et al: Effects of cerebral air embolism on circulating catecholamines and angiotensin. Undersea Biomed Res 6 (Suppl l):30, 1979

    • Search Google Scholar
    • Export Citation
  • 14.

    Fink BR: Paradoxical preservation of neural conduction by lidocaine. Anesthesiology 57:167171, 1982 Fink BR: Paradoxical preservation of neural conduction by lidocaine. Anesthesiology 57:167–171, 1982

    • Search Google Scholar
    • Export Citation
  • 15.

    Fritz H, & Hossmann KA: Arterial air embolism in the cat brain. Stroke 10:581589, 1979 Fritz H, Hossmann KA: Arterial air embolism in the cat brain. Stroke 10:581–589, 1979

    • Search Google Scholar
    • Export Citation
  • 16.

    Geddes IC, & Quastel JH: Effects of local anaesthetics on respiration of rat brain cortex in vitro. Anesthesiology 17:666671, 1956 Geddes IC, Quastel JH: Effects of local anaesthetics on respiration of rat brain cortex in vitro. Anesthesiology 17:666–671, 1956

    • Search Google Scholar
    • Export Citation
  • 17.

    Gillen HW: Symptomatology of cerebral gas embolism. Neurology 18:507512, 1968 Gillen HW: Symptomatology of cerebral gas embolism. Neurology 18:507–512, 1968

    • Search Google Scholar
    • Export Citation
  • 18.

    Hallenbeck JM, & Furlow TW: Impaired microvascular perfusion and secondary deterioration in dysbaric cerebral air embolism, in Hallenbeck JM, & Greenbaum LJ Jr (eds): Arterial Air Embolism and Acute Stroke. Bethesda, Md: Undersea Medical Society, 1977, pp 7686 Hallenbeck JM, Furlow TW: Impaired microvascular perfusion and secondary deterioration in dysbaric cerebral air embolism, in Hallenbeck JM, Greenbaum LJ Jr (eds): Arterial Air Embolism and Acute Stroke. Bethesda, Md: Undersea Medical Society, 1977, pp 76–86

    • Search Google Scholar
    • Export Citation
  • 19.

    Hallenbeck JM, & Furlow TW Jr: Prostaglandin I2 and indomethacin prevent impairment of post-ischemic brain reperfusion in the dog. Stroke 10:629637, 1979 Hallenbeck JM, Furlow TW Jr: Prostaglandin I2 and indomethacin prevent impairment of post-ischemic brain reperfusion in the dog. Stroke 10:629–637, 1979

    • Search Google Scholar
    • Export Citation
  • 20.

    Hallenbeck JM, , Leitch DR, & Dutka AJ, et al: PGI2, indomethacin, and heparin promote post-ischemic neuronal recovery in dogs when administered therapeutically. Stroke 12:117, 1981 (Abstract) Hallenbeck JM, Leitch DR, Dutka AJ, et al: PGI2, indomethacin, and heparin promote post-ischemic neuronal recovery in dogs when administered therapeutically. Stroke 12:117, 1981 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 21.

    Hart GB: Treatment of decompression illness and air embolism with hyperbaric oxygen. Aerosp Med 45:11901193, 1974 Hart GB: Treatment of decompression illness and air embolism with hyperbaric oxygen. Aerosp Med 45:1190–1193, 1974

    • Search Google Scholar
    • Export Citation
  • 22.

    Haschke RH, & Fink BR: Lidocaine effects on brain mitochondrial metabolism in vitro. Anesthesiology 42:737740, 1975 Haschke RH, Fink BR: Lidocaine effects on brain mitochondrial metabolism in vitro. Anesthesiology 42:737–740, 1975

    • Search Google Scholar
    • Export Citation
  • 23.

    Iragui-Madoz VJ, & Wiederholt WC: Far-field somatosensory evoked potentials in the cat: correlation with depth recording. Ann Neurol 1:569574, 1977 Iragui-Madoz VJ, Wiederholt WC: Far-field somatosensory evoked potentials in the cat: correlation with depth recording. Ann Neurol 1:569–574, 1977

    • Search Google Scholar
    • Export Citation
  • 24.

    Kinsey JL: Air embolism as a result of submarine escape training. US Armed Serv Med J 5:243255, 1954 Kinsey JL: Air embolism as a result of submarine escape training. US Armed Serv Med J 5:243–255, 1954

    • Search Google Scholar
    • Export Citation
  • 25.

    Kobrine AI, , Evans DE, & Rizzoli HV: Correlation of spinal cord blood flow and function in experimental compression. Surg Neurol 10:5459, 1978 Kobrine AI, Evans DE, Rizzoli HV: Correlation of spinal cord blood flow and function in experimental compression. Surg Neurol 10:54–59, 1978

    • Search Google Scholar
    • Export Citation
  • 26.

    Kobrine AI, , Evans DE, & Rizzoli HV: The effects of ischemia on long-tract neural conduction in the spinal cord. J Neurosurg 50:639644, 1979 Kobrine AI, Evans DE, Rizzoli HV: The effects of ischemia on long-tract neural conduction in the spinal cord. J Neurosurg 50:639–644, 1979

    • Search Google Scholar
    • Export Citation
  • 27.

    Kobrine AI, , Evans DE, & Rizzoli HV: Effects of progressive hypoxia on long tract neural conduction in the spinal cord. Neurosurgery 7:369375, 1980 Kobrine AI, Evans DE, Rizzoli HV: Effects of progressive hypoxia on long tract neural conduction in the spinal cord. Neurosurgery 7:369–375, 1980

    • Search Google Scholar
    • Export Citation
  • 28.

    Kobrine AI, , Evans DE, & Rizzoli HV: Experimental acute balloon compression of the spinal cord. Factors affecting disappearance and return of the spinal evoked response. J Neurosurg 51:841845, 1979 Kobrine AI, Evans DE, Rizzoli HV: Experimental acute balloon compression of the spinal cord. Factors affecting disappearance and return of the spinal evoked response. J Neurosurg 51:841–845, 1979

    • Search Google Scholar
    • Export Citation
  • 29.

    Kobrine AI, , Evans DE, & Rizzoli HV: Relative vulnerability of the brain and spinal cord to ischemia. J Neurol Sci 45:6572, 1980 Kobrine AI, Evans DE, Rizzoli HV: Relative vulnerability of the brain and spinal cord to ischemia. J Neurol Sci 45:65–72, 1980

    • Search Google Scholar
    • Export Citation
  • 30.

    Marquardt DW: An algorithm for least-squares estimation of non-linear parameters. J Soc Indust Appl Math 11:431441, 1963 Marquardt DW: An algorithm for least-squares estimation of non-linear parameters. J Soc Indust Appl Math 11:431–441, 1963

    • Search Google Scholar
    • Export Citation
  • 31.

    Millikan CH, & McDowell FH: Treatment of progressing stroke. Prog Cardiovasc Dis 22:397414, 1980 Millikan CH, McDowell FH: Treatment of progressing stroke. Prog Cardiovasc Dis 22:397–414, 1980

    • Search Google Scholar
    • Export Citation
  • 32.

    Sakabe T, , Maekawa T, & Ishikawa T, et al: The effects of lidocaine on canine cerebral metabolism and circulation related to the electroencephalogram. Anesthesiology 40:433441, 1974 Sakabe T, Maekawa T, Ishikawa T, et al: The effects of lidocaine on canine cerebral metabolism and circulation related to the electroencephalogram. Anesthesiology 40:433–441, 1974

    • Search Google Scholar
    • Export Citation
  • 33.

    Waite CL, , Mazzone WF, & Greenwood ME, et al: Dysbaric cerebral air embolism, in Lambertson CJ (ed): Proceedings of the Third Symposium on Underwater Physiology. Baltimore: Williams & Wilkins, 1967, pp 205215 Waite CL, Mazzone WF, Greenwood ME, et al: Dysbaric cerebral air embolism, in Lambertson CJ (ed): Proceedings of the Third Symposium on Underwater Physiology. Baltimore: Williams & Wilkins, 1967, pp 205–215

    • Search Google Scholar
    • Export Citation
  • 34.

    Ward WK, , Shadforth M, & Hill AVL, et al: Air embolism during haemodialysis. Br Med J 3:7478, 1971 Ward WK, Shadforth M, Hill AVL, et al: Air embolism during haemodialysis. Br Med J 3:74–78, 1971

    • Search Google Scholar
    • Export Citation
  • 35.

    Winter PM, , Alvis HJ, & Gage AA: Hyperbaric treatment of cerebral air embolism during cardiopulmonary bypass. JAMA 215:17861788, 1971 Winter PM, Alvis HJ, Gage AA: Hyperbaric treatment of cerebral air embolism during cardiopulmonary bypass. JAMA 215:1786–1788, 1971

    • Search Google Scholar
    • Export Citation

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