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Lidocaine Does Not Depress Reflex Dilation of the Pupil
  1. Merlin D. Larson, M.D.*,
  2. Andrea Kurz, M.D.*,
  3. Daniel I. Sessler, M.D.*,
  4. Martha Dechert, B.A.*,
  5. Farzin Tayefeh, M.D.* and
  6. Andrew R. Bjorksten, Ph.D
  1. *Department of Anesthesia, University of California, San Francisco and the
  2. Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Victoria, Australia
  1. Reprint requests: Dr. M.D. Larson, Department of Anesthesia, University of California, 521 Parnassus Avenue, Room C450, Box 0648, San Francisco, CA, 94143-0648.


Background and Objectives Pupillary dilation in response to dermatomal electrical stimulation is one method of determining sensory block level during combined epidural and general anesthesia. Use of this technique may, however, be confounded by systemic absorption of epidurally administered local anesthetics. Accordingly, the effects of intravenous lidocaine on the magnitude and duration of reflex pupillary dilation were evaluated.

Methods Six volunteers were each anesthetized twice with desflurane 3.5-6.0%. During one anesthetic, intravenous lidocaine was administered to a plasma concentration of 5.3 ± 1.5 μg/mL. When the plasma concentrations were stable, a 5-second tetanic electrical stimulus was applied. Pupil size was then recorded for 8 minutes.

Results Lidocaine, at plasma concentrations near 5 μg/mL, did not significantly alter the pupillary response to electrical stimulation. In contrast, stimulus-induced increase in heart rate was obliterated. Painful stimulation did not increase systolic blood pressure in either case.

Conclusions Typical plasma lidocaine concentrations observed during epidural anesthesia are unlikely to prevent the use of pupillary responses to evaluate sensory block level.

  • pupil size
  • reflex dilation
  • desflurane lidocaine

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  • This work was supported by NIH Grant GM49670, Fairville Medical Optics, Inc. (Amersham, England), and the Joseph Drown (Los Angeles, CA) and Erwin-Schrödinger (Vienna, Austria) Foundations.