Lokalanästhetika und bronchiale Hyperreagibilität

Zusammenfassung.

Patienten mit bronchialer Hyperreagibilität haben ein erhöhtes Risiko eines Bronchospasmus bei Manipulation ihrer Atemwege im Rahmen einer In- oder Extubation sowie Bronchoskopie, so dass eine Prophylaxe sinnvoll ist. Die Wirksamkeit der Prophylaxe einer Reflexbronchokonstriktion ist sowohl für inhalativ und intravenös appliziertes Lidocain auch für das β₂- Mimetikum Salbutamol als Aerosol nachgewiesen. Beide erhöhen die Histaminschwelle um mehr als das doppelte (2,2- bzw. 2,6-fach) und sind damit ähnlich effektiv. Darüber hinaus hat die kombinierte Applikation von Lidocain und Salbutamol einen additiven Effekt auf die Histaminschwelle (Anhebung auf das 4,8 fache). Der Einsatz von Lidocain ist demnach auch bei Patienten von Nutzen, die wegen einer Atemwegserkrankung mit β₂-Mimetika therapiert werden. Inhalativ und intravenös appliziertes Lidocain ist bei unterschiedlich hohen Plasmakonzentrationen wirksam, nämlich nach Inhalation bei 0,7 µg/ml, nach intravenöser Gabe bei ca. 2 µg/ml. Die Inhalation hat den Vorteil der niedrigeren Plasmakonzentration, als Nachteil oft eine initiale Bronchokonstriktion sowie eine Sensibilitätsstörung im Pharynx und Larynx. Demgegenüber ist die intravenöse Applikation einfach, führt aber zu höheren Plasmakonzentrationen mit häufigeren systemischen Nebenwirkungen. Zur Wirksamkeit von Lokalanästhetika in der Therapie von Bronchospasmen liegen dagegen bislang keine kontrollierten Studien vor. Insgesamt bereichert die prophylaktische Anwendung von Lokalanästhetika bei Patienten mit vermuteter oder nachgewiesener bronchialer Hyperreagibilität das Spektrum der perioperativen Pharmakotherapie.

Local Anesthetics and Bronchial Hyperreactivity.

Patients with bronchial hyperreactivity are at increased risk for bronchospasm particularly during airway instrumentation such as with intubation, extubation, or bronchoscopy. Pretreatment with either lidocaine or salbutamol is suggested, since application of lidocaine intravenously or salbutamol as an aerosol has been shown to be similarly effective in increasing the (2,2 resp. 2,6 fold) threshold for histamine evoked bronchoconstriction. Furthermore, combined salbutamol and lidocaine pretreatment has an additive effect and increases 4,8 fold the histamine-threshold. Thus, lidocaine treatment can be applied to patients with airway disease treated with β₂-mimetics also. Inhaled and injected lidocaine is equally effective in decreasing histamine threshold although at different plasma concentrations, i. e., lidocaine is effective at approx. 0,7 µg/ml after inhalation but at up to 2 µg/ml after injection. While inhaled lidocaine results in lower plasma concentrations it can evoke an initial bronchoconstriction. Furthermore, local anesthesia of pharynx and larynx associated with inhalation may not be tolerable in some patients. Intravenous lidocaine, in contrast, results in higher plasma concentrations and side-effects are seen more often. While several case reports have described beneficial effects of lidocaine in the treatment of bronchospasm no clinical studies have been performed. Overall, both inhaled and injected local anesthetics are effective in mitigating reflex mediated bronchoconstriction.

Schlüsselwörter:

Bronchiale Hyperreagibilität - Lokalanästhetika - Lidocain - Salbutamol

Key words:

Airways - Bronchial hyperreactivity - Bronchospasm - Local anesthetics - Lidocaine - Salbutamol

Literatur

• 1 Ammit A J, Armour C L, Black J L. Smooth-muscle myosin light-chain kinase content is increased in human sensitized airways.  Am J Respir Crit Care Med. 2000;  161 257-263
• 2 Barnes P J. Neural control of human airways in health and disease.  Am Rev Respir Dis. 1986;  134 1289-1314
• 3 Barnes P J. Neuropeptides and asthma.  Am Rev Respir Dis. 1991;  143 S28-S32
• 4 Barnes P J. Modulation of neurotransmission in airways.  Physiol Rev. 1992;  72 699-728
• 5 Barnes P J. Asthma: The important questions. 2.  What is the role of nerves in chronic asthma and symptoms? Am J Respir Crit Care Med. 1996;  153 S5-S7
• 6 Beydon L, Lorino A M, Verra F, Labroue M, Catoire P, Lofaso F, Bonnet F. Topical upper airway anaesthesia with lidocaine increases airway resistance by impairing glottic function.  Intensive Care Med. 1995;  21 920-926
• 7 Black J L. Asthma: The important questions. 1. Role of airway smooth muscle.  Am J Respir Crit Care Med. 1996;  153 S1-S4
• 8 Bleeker E R, Rosenthal R R, Menkes H A, Norman P S, Permutt S. Physiologic effects of inhaled histamine in asthma: reversible changes in pulmonary mechanics and total lung capacity.  J Allergy Clin Immunol. 1979;  64 597-602
• 9 Boushey H A, Holtzman M J, Sheller J R, Nadel J A. State of the art: bronchial hyperreactivity.  Am Rev Respir Dis. 1980;  121 389-413
• 10 Braid D P, Scott D B. Dosage of lignocaine in epidural block in relation to toxicity.  Brit J Anaesth. 1966;  38 596-602
• 11 Brown R H, Robbins W, Staats P, Hirshman C. Prevention of bronchoconstriction by an orally active local anesthetic.  Am J Respir Crit Care Med. 1995;  151 1239-1243
• 12 Bulut Y, Hirshman C A, Brown R H. Prevention of lidocaine aerosol-induced bronchoconstriction with intravenous lidocaine.  Anesthesiology. 1996;  85 853-859
• 13 Butterworth J F, Strichartz G R. Molecular mechanisms of local anesthesia: a review.  Anesthesiology. 1990;  72 711-734
• 14 Caranza R, Nandwani N, Tring J P, Thompson J P, Smith G. Upper airway reflex sensivity following general anaesthesia for day-case surgery.  Anesthesia. 2000;  55 367-390
• 15 Carstairs J R, Nimmo A J, Barnes P J. Autoradiographic visualization of beta-adrenoreceptor subtypes in the human lung.  Am Rev Respir Dis. 1985;  132 541-547
• 16 Casale T B. Neuromechanisms of asthma.  Ann Allergy. 1987;  59 391-397
• 17 Cheney T W, Posner K l, Caplan R A. Adverse respiratory events infrequently leading to malpractice suits. A closed claims analysis.  Anesthesiology. 1991;  75 932-939
• 18 Chinn W M, Zavala D C, Ambre J. Plasma levels of lidocaine following aerosol administration.  Chest. 1977;  71 346-348
• 19 Choudry N B, Fuller R W, Anderson N, Karlsson J -A. Separation of cough and reflex bronchoconstriction by inhaled local anesthetics.  Eur Respir J. 1990;  3 579-583
• 20 Cohen M M, Cameron C B. Should you cancel the operation when a child has an upper respiratory tract infection?.  Anesth Analg.. 1991;  72 282-288
• 21 Cuttitta G, Cibella F, Visconti A, Scichilone N, Bellia V, Bonsignore G. Spontaneous Gastroesophageal reflux and airway patency during the night in adult asthmatics.  Am J Respir Crit Care Med. 2000;  161 177-181
• 22 Davis C, Kannan M S. Sympathetic innervation of human tracheal and bronchial smooth muscle.  Resp Physiol. 1987;  68 53-61
• 23 Denburg J A. Asthma: The important questions. 4. The inflammatory response.  Am J Respir Crit Care Med. 1996;  153 S12-S13
• 24 Desjardins A, Luca S D, L'Archevêque J, Ghezzo H, Malo J L. Nonspecific bronchial hyperresponsiveness to inhaled histamine and hyperventilation of cold dry air in subjects with respiratory symptoms of uncertain etiology.  Am Rev Respir Dis. 1988;  137 1020-1025
• 25 Donegan M F, Bedford R F. Intravenously administered lidocaine prevents intracranial hypertension during endotracheal suctioning.  Anesthesiology. 1980;  52 516-518
• 26 Downes H, Loehning R W. Local anesthetic contracture and relaxation of airway smooth muscle.  Anesthesiology. 1977;  47 430-436
• 27 Downes H, Gerber N, Hirshman C A. I.V. lignocaine in reflex and allergic bronchoconstriction.  Br J Anaesth. 1980;  52 873-878
• 28 Downes H, Hirshman C A, Leon D A. Comparison of local anaesthetics as bronchodilatator aerosols.  Anesthesiology. 1983;  58 216-220
• 29 Eiser N M, Kerrebjin K F, Quanjer P H. Guidelines for standardization of bronchial challenges with (nonspecific) bronchoconstricting agents.  Bull Europ Physiopath Resp. 1983;  19 495-514
• 30 Empey D W, Laitinen L A, Jacobs L, Gold W M, Nadel J A. Mechanisms of bronchial hyperreactivity in normal subjects after upper respiratory tract infection.  Am Rev Respir Dis. 1976;  113 131-139
• 31 Enright P L, McNally J F, Souhrada J F. Effect of lidocaine on the ventilatory and airway responses to exercise in asthmatics.  Am Rev Respir Dis. 1980;  122 823-828
• 32 Fryer A D, Yarkony K A, Jacoby D B. The effect of leukocyte depletion on pulmonary M2 muscarinic receptor function in parainfluenza virus-infected guinea-pigs.  Br J Pharmacol. 1994;  112 588-594
• 33 Fryer A D, Jacoby D B. Muscarinic receptors and control of airway smooth muscle.  Am J Respir Crit Care Med. 1998;  158 S154-S160
• 34 Gal T J. Bronchial hyperresponsiveness and anesthesia: physiologic and therapeutic perspectives.  Anesth Analg. 1994;  78 559-573
• 35 Groeben H, Schwalen A, Irsfeld S, Tarnow J, Lipfert P, Hopf H B. High thoracic epidural anesthesia does not alter airway resistance and attenuates the response to an inhalational provocation test in patients with bronchial hyperreactivity.  Anesthesiology. 1994;  81 868-874
• 36 Groeben H, Schwalen A, Irsfeld S, Stieglitz S, Lipfert P, Hopf B. Intravenous lidocaine dose-dependently attenuate bronchial hyperreactivity in awake volunteers.  Anesthesiology. 1996;  84 533-539
• 37 Groeben H, Foster W M, Brown R H. Intravenous lidocaine and oral mexiletine block reflex bronchoconstriction in asthmatic subjects.  Am J Respir Crit Care Med. 1996;  154 885-888
• 38 Groeben H, Silvanus M -T, Beste M, Peters J. Combined intravenous lidocaine and inhaled salbutamol protect against bronchial hyperreactivity more effectively than lidocaine or salbutamol alone.  Anesthesiology. 1998;  89 862-868
• 39 Groeben H, Silvanus M T, Beste M, Peters J. Both intravenous and inhaled lidocaine attenuate reflex bronchoconstriction but at different plasma concentrations.  Am J Respir Crit Care Med. 1999;  159 530-535
• 40 Groeben H, Großwendt T, Silvanus M T, Beste M, Peters J. Lidocaine inhalation for anaesthesia and attenuation of bronchial hyperreactivity with least airway irritation: effect of three different dose regimens. E J A im Druck
• 41 Groeben H, Silvanus M T, Beste M, Peters J. Combined lidocaine and salbutamol inhalation for airway anesthesia markedly protects against reflex bronchoconstriction. Chest im Druck
• 42 Hall A P, Fox A J, Raphael J H, Nandwani N, Smith G. Upper airway reactivity and upper respiratory tract infection: effect of nebulized lidocaine.  Br J Anaesth. 1999;  82 857-860
• 43 Hirshman C A, Bergman N A. Factors influencing intrapulmonary airway calibre during anaesthesia.  Brit J Anaesth. 1990;  65 30-42
• 44 Hogan Q H, Stadnicka A, Stekiel T A, Bosnjak Z J, Kampine J P. Effects of epidural and systemic lidocaine on sympathetic activity and mesenteric circulation in rabbits.  Anesthesiology. 1993;  79 1250-1260
• 45 Ishikawa T, Sekizawa S-I, Sant'Ambrogio F B, Sant'Ambrogio G. Larynx vs. esophagus as reflexogenic site for acid-induced bronchoconstriction in dogs.  J Appl Physiol. 1999;  86 1226-1230
• 46 Islam M S, Ulmer W T. Tracheal contractility and flow resistance in anesthesized dogs with and without vagal block.  Respir. 1979;  37 7-14
• 47 Jalowy A, Peters J, Groeben H. Stellenwert der bronchialen Hyperreagibilität in der Anästhesiologie.  AINS. 1998;  33 150-162
• 48 Jensen E J, Dahl R, Steffensen F. Bronchial reactivity to cigarette smokers: repeatability, relationship to methacholine reactivity, smoking and atopy.  Eur Respir J. 1998;  11 670-676
• 49 Kai T, Nishimura J, Kobayashi, Takahashi S, Yoshitake J, Kanaide H. Effect of lidocaine on intracellular Ca²⁺ and tension in airway smooth muscle. Anesthesiology 1993: 954-965
• 50 Karlsson J A, Sant¿Ambrogio G, Widdicombe J. Afferent neural pathways in cough and reflex bronchoconstriction.  J Appl Physiol. 1988;  65 1007-1023
• 51 Kasaba T, Tanaka N, Takasaki M. Effect of epidural anesthesia on airway constriction induced with methacholine or capsaicin in cats.  Masui. 1998 [abstract];  47 939-943
• 52 Kimura K, Inoue H, Ichinose M, Mirua M, Katsumata U, Takahashi T, Takishima T. Bradykinin causes airway hyperresponsiveness and enhances maximal airway narrowing.  Am Rev Respir Dis. 1992;  146 1301-1305
• 53 Kirkpatrick M B, Sanders R V, Bass J B. Physiologic effects and serum lidocaine concentrations of lidocaine from a compressed gas-powered jet nebulizer.  Am Rev Respir Dis. 1987;  136 447-449
• 54 Koppert W, Ostermeier N, Sittl R, Weidner C, Schmelz M. Low-dose lidocaine reduces secondary hyperalgesia by a central mode of action.  Pain. 2000;  85 217-224
• 55 Lee L Y, Kou Y R, Frazier D T, Beck E R, Pisarri T E, Coleridge H M, Coleridge J C. Stimulation of vagal pulmonary C-fibers by a single breath of cigarette smoke in dogs.  J Appl Physiol. 1989;  66 2032-2038
• 56 Lipfert P. Pharmakologie von Lokalanästhetika. In: Doenicke A, Kettler D, List WF, Radke J, Tarnow J (Hrsg.) Anästhesiologie. Berlin, Heidelberg, New York, Tokyo; Springer Verlag 1995: 232-272
• 57 Louis R, Lau L CK, Bron A O, Roldaan A C, Radermacher M, Djukanovic R. The relationship between airways inflammation and asthma severity.  Am J Respir Crit Care Med. 2000;  161 9-16
• 58 Lundberg J M, Alving K, Lacroix J S, Matran. Local and central reflex mechanisms in the neural control of airway microcirculation. Eur Respir J 1990: S624-628
• 59 Magi C A, Meli A. The sensory-efferent function of capsaicin-sensitive neurons.  Gen Pharmacol. 1988;  19 1-43
• 60 Manning P J, Jones G L, O'Byrne P M. Tachyphylaxis to inhaled histamine in asthmatic subjects.  J Appl Physiol. 1987;  63 1572-1577
• 61 Manning P J, O'Byrne P M. Histamine bronchoconstriction reduces airway responsiveness in asthmatic subjects.  Am Rev Respir Dis. 1988;  137 1323-1325
• 62 McAlpine L G, Thomson N C. Lidocaine-induced bronchoconstriction in asthmatic patients. Relation to histamine airway responsiveness and effect of preservative.  Chest. 1989;  96 1012-1015
• 63 Miller B D, Thames M D, Mark A L. Inhibition of cardiac sympathetic nerve activity during intravenous administration of lidocaine.  J Clin Invest. 1983;  83 1247-1253
• 64 Mitchell H W, Gray P R. Assessment of the dynamic relationship between external diameter and lumen flow in isolated bronchi.  Resp Physiol. 1999;  116 67-76
• 65 Morgan G E, Mikhail M S. Anesthesia for Patients With Respiratory Disease. In: Clinical Anesthesiology. econd Edition. Appleton & Lange, Stamford 1996: 444-445
• 66 Nadel J A, Borson D B. Modulation of neurogenic inflammation by neutral endopeptidase.  Am Rev Respir Dis. 1991;  143 S33-36
• 67 Nielson D W, Philip L K, Egger M. Topical lidocaine exaggerates laryngomalacia during flexible bronchoscopy.  Am J Respir Crit Care Med. 2000;  161 147-151
• 68 Nietgen G W, Chan C K, Durieux M E. Inhibition of lysohosphatidate signaling by lidocaine and bupivacaine.  Anesthesiology. 1997;  86 1112-1119
• 69 Nietgen G W, Höhnemann C W, Durieux M E. Influence of anesthetics on endogenous and recombinantly expressed G protein-coupled receptors in the Xenopus oocyte.  Toxicology Letters. 1998;  100/101 319-327
• 70 Nishikawa K, Teral T, Morimoto O, Yukioka H, Fujimori M. Effects of intravenous lidocaine on cardiac nerve activity and A-V conduction in halothane-anesthetized cats.  Acta Anaesthesiol Scand. 1994;  38 115-120
• 71 Nishino T, Hiraga K, Sugimori K. Effects of i. v. lignocaine on airway reflexes elicited by irritation of the tracheal mucosa in humans anaesthestized with enflurane.  Br J Anaesth. 1990;  64 682-687
• 72 Nishino T, Hiraga K, Mizuguchi, Honda Y. Respiratory reflex responses to stimulation of tracheal mucosa in enflurane-anesthestized humans.  J Appl Physiol. 1988;  65 1069-1074
• 73 Nosaka S, Kamaya H, Ueda I, Wong K C. Smooth muscle contraction and local anesthetics: Calmodulin-dependent myosin light-chain kinase.  Anesth Analg. 1989;  69 504-510
• 74 Ohashi Y, Motojima S, Fukada T, Makino S. Airway hyperresponsiveness. Increased intracellular spaces of bronchial epithelium, and increased infiltration of eosinophils and lymphocytes in bronchial mucosa in asthma.  Am Rev Respir Dis. 1992;  145 1469-1476
• 75 Osborn H H, Tang M, Bradley K, Duncan B R. New-onset bronchospasm or recrudescence of asthma associated witch cocaine abuse.  Acad Emerg Med. 1997;  4 689-692
• 76 Olsson G L. Bronchospasm during anaesthesia. A computer-aided incidence study of 136929 patients.  Acta Anaesthesiol Scand. 1987;  31 244-252
• 77 Peat J K, Salome C M, Woolcock A J. Longitudinal changes in atopy during a 4-year period: relation to bronchial hyperresponsiveness and respiratory symptoms in a population sample of Australian schoolchildren.  J Allergy Clin Immunol. 1990;  85 65-74
• 78 Pizov R, Brown R H, Weiss Y S, Baranov D, Hennes H, Baker S, Hirshman C A. Wheezing during induction of general anesthesia in patients with and without asthma.  Anesthesiology. 1995;  82 1111-1116
• 79 Pretolani M, Vargaftig B B. From lung hypersensitivity to bronchial hyperreactivity.  Biochem Pharmacol. 1993;  45 791-800
• 80 Ramsdell J W, Nachtwey F J, Moser K M. Bronchial hyperreactivity in chronic obstructive bronchitis.  Am Rev Respir Dis. 1982;  126 829-832
• 81 Richardson J B. State of the art: Nerve supply to the lungs.  Am Rev Respir Dis. 1979;  119 785-802
• 82 Schultze-Werninghaus G, Morgenroth K, Schmidts L. Die Pathophysiologie von allergischer Bronchialobstruktion und bronchialer Hyperreaktivität.  Prax Klin Pneumol. 1987;  41 627-632
• 83 Shono S, Higa K, Harasawa I, Sugano H, Dan K. Disappearance of wheezing during epidural lidocaine anaesthesia in a patient with asthma.  Reg Anesth Pain Med. 1999;  24 463-464
• 84 Sellick H, Widdicombe J G. Stimulation of lung irritant receptors by cigarette smoke, carbon dust, anf histamine aerosol.  J Appl Physiol. 1971;  31 15-19
• 85 Shore S A, Bai T R, Wang C G, Martin J G. Central and local cholinergic components of histamine-induced bronchoconstriction in dogs.  J Appl Physiol. 1985;  58 443-451
• 86 Silbernagel S, Despopoulos A. Taschenatlas der Physiologie. Thieme Verlag, Stuttgart, New York 4
• 87 Snashall P D, Chung K F. Airway obstruction and bronchial hyperresponsiveness in left ventricular failure and mitral stenosis.  Am Rev Respir Dis. 1991;  144 945-956
• 88 Stahnke J. Geschichtliches zur Lokalanästhesie.  Münch Med Wschr. 1980;  122 1236-1238
• 89 Stevens R A, Artuso J D, Kao T C, Bray J G, Spitzer L, Louwsma D L. Changes in human plasma catecholamine concentrations during epidural anesthesia depend on the level of block.  Anesthesiology. 1991;  74 1029-1034
• 90 Tam S, Chung F, Campbell M. Intravenous lidocaine: Optimal time of injection before tracheal intubation.  Anesth Analg. 1987;  66 1036-1038
• 91 Toelle B G, Peat J K, Salome C M, Mellis C M, Woolcock A J. Toward a definition of asthma for epidemiology.  Am Rev Respir Dis. 1992;  146 633-637
• 92 Tigyi G, Hong L, Yakubu M, Parfenova H, Shibata M, Leffler C W. Lysophosphatidic acid alters cerebrovascular reactivity in piglets. Am J Physiol (Heart Circ Physiol) 1995: H2048-2055
• 93 Tricot J P. Cocaine: half a century of therapeutic use (1880 - 1930).  Verh K Acad Geneeskd Belg. 1991;  53 487-496
• 94 Ulmer W T, Islam M S. Die Azetylcholinempfindlichkeit des Bronchialbaumes.  Respir. 1974;  31 137-145
• 95 Warner D O, Warner M A, Barnes R D, Offord K P, Schroeder D R, Gray D T, Yunginger J W. Perioperative respiratory complications in patients with asthma.  Anesthesiology. 1996;  85 460-467
• 96 Warner D O, Warner M A, Offord K P, Schroeder D R, Maxson P, Scanion P D. Airway obstruction and perioperative complications in smokers undergoing abdominal surgery.  Anesthesiology. 1999;  90 372-379
• 97 Weiss E B, Anderson W H, O`Brien K P. The effect of a local anesthetic, lidocaine, on guinea pig trachealis muscle in vitro.  Am Rev Respir Dis. 1975;  112 393-400
• 98 Weiss E B, Hargraves W A, Viswanath S G. The inhibitory action of lidocaine in anaphylaxis.  Am Rev Respir Dis. 1978;  117 859-869
• 99 Wellhöner H-H. Allgemeine und systematische Pharmakologie und Toxikologie. Berlin, Heidelberg, New York; Springer-Verlag 1990 5
• 100 Widdicombe J G. Autonomic regulation: i-NANC/e-NANC.  Am J Respir Crit Care Med. 1998;  158 S 171-175
• 101 Wilson N, Chudry N, Silverman M. Role of oesophagus in asthma induced by the ingestion of ice and acid.  Thorax. 1987;  42 506-510
• 102 Ye J H, Ren J, Krnjevic K, Liu P L, McArdle J J. Cocaine and lidocaine have additive inhibitory effects of acutely dissociated hippocampal pyramidal neurons.  Brain Res. 1999;  821 26-32
• 103 Zipf H F. The pharmacology of viscero-afferent receptors with special reference to endoanaesthesia.  Acta Neuroveg. 1966;  29 169-196
• 104 Zipf H F, Reichertz P. Darstellung der totalen und reversiblen Endoanästhesie der Lungendehnungsrezeptoren durch Wirkung/ Dosis-Zeit-Kurven.  Naunyn Schmiedebergs Arch Exp Pathol Pharmacol. 1957;  231 96-110