Effect of lidocaine on production of migration inhibitory factor and on macrophage motility: in vitro exposure of guinea pig lymphocytes and macrophages.

Exposure of lymphocytes from guinea pigs sensitized to keyhole limpet hemocyanin and of macrophages from nonsensitized animals to noncytotoxic doses of lidocaine (10(-4) to 10(-6) M) resulted in the inhibition of the production of macrophage migration inhibitory factor and of macrophage motility. The inhibition of both processes was related to the concentration of lidocaine in the medium. The effects of lidocaine, a membrane-stabilizing drug, were apparently related to its ability to interact with the cell surface and cause changes in the surface ionic configuration of the cells, as determined by cell electrophoresis. The drug conferred permanent changes in the surface of lymphocytes at all concentrations tested, but the changes in the surface of macrophages induced in the presence of 10(-5) and 10(-6) M of the drug were reversible. The presence of noncytotoxic doses of lidocaine in the cellular environment resulted in significant changes in cellular functions that appeared to be related to the ability of the drug to interact with cell membranes in a manner determined by the specific surface properties of the cell.

Prognostic significance of the development of left bundle conduction defects following aortic valve replacement.

The association of intraventricular conduction defects and aortic valvular disease is widely recognized. This study was undertaken to evaluate the effects on survival of left bundle conduction defects (LBCDs) as a consequence of aortic valve replacement. A total of 133 patients were followed between 1 and 70 months after operation, with a mean follow-up of 32.1 months. The incidence of intraoperative LBCDs was 31.6% or 42 patients. There were 13 deaths in the group of 42 patients with LBCDs compared to eight deaths in the group of 91 patients without such abnormalities (p less than 0.01). Sudden death occurred in five of 42 patients with postoperative LBCDs and two of 91 patients with normal intraventricular conduction (p less than 0.025). The survival rate in these patients with significant aortic stenosis and normal intraventricular conduction was 89.9%, whereas if LBCD had occurred after operation, the survival rate was 65.7% (p less than 0.005). If the LBCD was accompanied by a left axis deviation, the survival rate was 21.7%. Sudden death may be due either to a tachyarrhythmia or perhaps to progression from LBCD to complete heart block or trifascicular block. It is important that this group of patients be monitored closely after operation. There may be an indication to insert prophylactic permanent pacemakers in this group.

Prophylactic digitalization for coronary artery bypass surgery.

One hundred and twenty patients undergoing aortocoronary bypass procedures were randomly placed into control and digitalized groups. All were initially in normal sinus rhythm and without evidence of congestive heart failure. Supraventricular arrhythmias occurred in 17 of 66 controls and in only three of 54 digitalized patients (P less than 0.01). There was no evidence of digitals toxicity. Based on this evidence we recommend prophylactic digitalization for patients having aortocoronary bypass operations.