Lidocaine metabolism pathophysiology, drug interactions, and surgical implications.

Bill, Timothy J; Clayman, Mark A; Morgan, Raymond F; Gampper, Thomas J · Aesthet Surg J · 2004

review · Level V

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Abstract

A thorough understanding of the pathophysiology of lidocaine metabolism is an important prerequisite to minimizing the risk of morbidity and mortality associated with lipoplasty. Although the tumescent technique has greatly improved the safety of large-volume lipoplasty through decreased blood loss and reduced anesthetic needs, it has introduced the possibility for lidocaine toxicity. Because lidocaine is metabolized by the cytochrome P450 system, the potential for drug interactions is heightened. These drug interactions are implicated as a cause of lidocaine toxicity. A comprehensive review of the patient's preoperative, intraoperative, and postoperative medication profile is critical to perioperative patient safety.