Lidocaine in cardioplegic solution

Kelly D. Hedlund, MS CCP

Lidocaine in cardioplegic solution
I’m calling on all chemistry experts to help me. In a post by Jorge Molina awhile back, it was stated that procaine was part of the original formulation of St. Thomas Hospital solution no. 1 (as developed by Braimbridge and Hearse). In 1981, the solution was modified by reducing slightly the potassium, sodium, and calcium concentrations. In addition, the procaine was omitted, based largely on FDA recommendations. This new solution (St. Thomas Hospital solution no. 2) is marketed in the U.S. as Plegisol. As an alternative to procaine, Braimbridge and Hearse suggested adding lidocaine to the no. 2 solution in a 1.0 mmole/liter concentration. So here’s where I’m a bit fuzzy. The molar mass of lidocaine is 234 grams. The molar mass of lidocaine HCl is 271 grams. In order to produce a lidocaine concentration of 1.0 mmole in a liter of Plegisol, roughly 250 mg would have to be added, correct? This seems like a lot of lidocaine when compared to Del Nido which contains 130 mg of lidocaine in a liter. Please weigh in all drug compounding guru’s!

Kelly D. Hedlund, MS, CCP
The Michael E. DeBakey Heart Institute
Hays Medical Center
Hays, Kansas

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