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Topic:Lidocaine

Lidocaine is a local anesthetic commonly used in equine medicine to manage pain and perform minor surgical procedures. It functions by blocking sodium channels, which inhibits nerve impulse conduction and results in temporary loss of sensation in targeted areas. In horses, lidocaine is utilized for various applications, including nerve blocks, epidural anesthesia, and as an adjunct in pain management protocols. Its pharmacokinetics, efficacy, and safety profile in equine patients are subjects of ongoing research. This page compiles peer-reviewed research studies and scholarly articles that explore the pharmacological properties, clinical applications, and potential side effects of lidocaine in horses.
Analgesic, behavioral, and hemodynamic and respiratory effects of midsacral subarachnoidally administered ropivacaine hydrochloride in mares.
Veterinary anaesthesia and analgesia    September 23, 2003   Volume 30, Issue 1 37-50 doi: 10.1046/j.1467-2995.2003.00094.x
Skarda RT, Muir WW.To determine the analgesic, behavioral, hemodynamic and respiratory effects of midsacral subarachnoid administration of ropivacaine hydrochloride solution in mares. Methods: Randomized, blinded study. Methods: Ten healthy mares, weighing from 470 to 560 kg. Methods: Intravascular and subarachnoid catheters were placed after infiltration of the skin and subcutaneous tissues with 2% lidocaine. Ropivacaine (0.2%, 5 mL) or 0.9% NaCl was then administered subarachnoidally at the midsacral (S2-S3) vertebrae. Analgesia was determined by lack of sensory perception to electrical stimulation (>40 mA)...
A comparison of the analgesic effects of caudal epidural methadone and lidocaine in the horse.
Veterinary anaesthesia and analgesia    September 23, 2003   Volume 30, Issue 3 156-164 doi: 10.1046/j.1467-2995.2003.00145.x
Olbrich VH, Mosing M.To evaluate and compare the effects of caudal epidural administration of methadone (METH) and lidocaine (LIDO) on tolerance to thermal stimulation over the dermatomes of the perineal, sacral, lumbar and thoracic regions in the horse. Methods: A blinded, randomized, prospective, experimental cross-over study. Methods: Seven healthy horses, 15.7 +/- 4.9 years (mean +/- SD) of age, weighing 536 +/- 37 kg. Methods: The horses were randomly assigned to receive two treatments (group M: METH, 0.1 mg kg-1 or group L: LIDO, 0.35 mg kg-1) at intervals of at least 28 days. An 18-gauge 80-mm Tuohy epidura...
Effects of intravenous lidocaine on isoflurane concentration, physiological parameters, metabolic parameters and stress-related hormones in horses undergoing surgery.
Journal of veterinary medicine. A, Physiology, pathology, clinical medicine    September 2, 2003   Volume 50, Issue 4 190-195 doi: 10.1046/j.1439-0442.2003.00523.x
Dzikiti TB, Hellebrekers LJ, van Dijk P.Physiological parameters, metabolic parameters and stress-related hormones are evaluated in horses anaesthetized with isoflurane in oxygen combined with lidocaine intravenously. Two groups of horses anaesthetized with isoflurane (six horses in each group) were studied: a lidocaine group (IL), which received intravenous lidocaine and a control group (C), which received intravenous saline. Horses in both groups were premedicated with detomidine (i.v.), and anaesthesia was induced with midazolam-ketamine (i.v.). The lidocaine group received intravenous lidocaine as a loading dose of 2.5 mg kg(-1)...
Intravenous lidocaine and small-intestinal size, abdominal fluid, and outcome after colic surgery in horses.
Journal of veterinary internal medicine    December 6, 2002   Volume 16, Issue 6 736-741 doi: 10.1892/0891-6640(2002)016<0736:ilassa>2.3.co;2
Brianceau P, Chevalier H, Karas A, Court MH, Bassage L, Kirker-Head C, Provost P, Paradis MR.Twenty-eight horses with the diagnosis of an intestinal disorder requiring surgical intervention were randomly assigned to lidocaine (n = 13) or saline (control, n = 15) treatment groups. After induction of anesthesia, treated horses received a loading dose of 2% lidocaine (0.65 mg/kg) intravenously, followed by a continuous rate of infusion of 1% lidocaine (0.025 mg/kg/min) until the discontinuation of anesthesia. Upon recovery from anesthesia, a 2nd loading dose of 2% lidocaine (1.3 mg/kg) was administered, followed by an infusion of 1% lidocaine (0.05 mg/kg/min) for 24 hours postoperatively...
Effects of intravenous lidocaine overdose on cardiac electrical activity and blood pressure in the horse.
Equine veterinary journal    September 18, 2001   Volume 33, Issue 5 434-437 doi: 10.2746/042516401776254871
Meyer GA, Lin HC, Hanson RR, Hayes TL.This study aimed to identify blood serum lidocaine concentrations in the horse which resulted in clinical signs of intoxication, and to document the effects of toxic levels on the cardiovascular and cardiopulmonary systems. Nineteen clinically normal mature horses of mixed breed, age and sex were observed. Lidocaine administration was initiated in each subject with an i.v. loading dose of 1.5 mg/kg bwt and followed by continuous infusion of 0.3 mg/kg bwt/min until clinical signs of intoxication were observed. Intoxication was defined as the development of skeletal muscle tremors. Prior to admi...
Equine muscular dystrophy with myotonia.
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology    February 13, 2001   Volume 112, Issue 2 294-299 doi: 10.1016/s1388-2457(00)00511-3
Montagna P, Liguori R, Monari L, Strong PN, Riva R, Di Stasi V, Gandini G, Cipone M.To describe a case of equine muscular dystrophy with myotonia. Methods: A 5-year-old horse presented with hypertrophy and delayed relaxation of the muscles of the hindlimbs from age 2 months. Testicular atrophy developed from 2 years of age. Action and percussion myotonia was associated with weakness in these muscles, and EMG showed diffuse myotonic discharges and myopathic features. Biopsy of the gluteal muscle showed adipose and connective tissue infiltration, marked variation in muscle fibre size, and moth-eaten, ring and whorled fibres. Results: Injection of apamin, a peptide blocker of ca...
Identification of lidocaine and its metabolites in post-administration equine urine by ELISA and MS/MS.
Journal of veterinary pharmacology and therapeutics    December 7, 2000   Volume 23, Issue 4 215-222 
Dirikolu L, Lehner AF, Karpiesiuk W, Harkins JD, Woods WE, Carter WG, Boyles J, Fisher M, Tobin T.Lidocaine is a local anesthetic drug that is widely used in equine medicine. It has the advantage of giving good local anesthesia and a longer duration of action than procaine. Although approved for use in horses in training by the American Association of Equine Practitioners (AAEP), lidocaine is also an Association of Racing Commissioners International (ARCI) Class 2 drug and its detection in forensic samples can result in significant penalties. Lidocaine was observed as a monoprotonated ion at m/z 235 by ESI+ MS/MS (electrospray ionization-positive ion mode) analysis. The base peak ion at m/...
Electrically elicited blink reflex in horses with trigeminal and facial nerve blocks.
American journal of veterinary research    May 3, 2000   Volume 60, Issue 10 1287-1291 
Anor S, Espadaler JM, Monreal L, Pumarola M.To reassess reference values for the components of the electrically induced blink reflex, document reference values for facial motor nerve conduction velocity, and demonstrate usefulness of the blink reflex as a diagnostic tool in peripheral facial and trigeminal nerve dysfunction in horses. Methods: 10 healthy adult horses (8 males, 2 females) without neurologic abnormalities. Methods: Blink reflex tests were performed by electrical stimulation of the supraorbital nerve and facial (auriculopalpebral) nerve. Reflex and direct muscle-evoked potentials of the orbicularis oculi muscles were recor...
In vitro effects of erythromycin, lidocaine, and metoclopramide on smooth muscle from the pyloric antrum, proximal portion of the duodenum, and middle portion of the jejunum of horses.
American journal of veterinary research    April 20, 2000   Volume 61, Issue 4 413-419 doi: 10.2460/ajvr.2000.61.413
Nieto JE, Rakestraw PC, Snyder JR, Vatistas NJ.To evaluate effects of erythromycin, lidocaine, and metoclopramide on smooth muscle of the pyloric antrum (PA), proximal portion of the duodenum (PD), and middle portion of the jejunum (MJ) of horses. Sample Population-Strips of smooth muscle from 7 horses. Methods: Isolated muscle strips were suspended in a bath and attached to isometric force transducers. Once stable spontaneous contractions were observed, agents were added. Isometric stress responses were compared with the amplitude of spontaneous contractions. Results: A single dose of erythromycin to the PA increased contractile amplitude...
[Hypothesis concerning the anatomical basis of cauda equina syndrome and transient nerve root irritation after spinal anesthesia].
Revista espanola de anestesiologia y reanimacion    May 6, 1999   Volume 46, Issue 3 99-105 
Reina MA, López A, de Andrés JA.Cauda equine syndrome is a rare neurological complication associated with subarachnoid anesthesia, and particularly with the use of 5% hyperbaric lidocaine and small gauge catheters. Our aim was to study a possible anatomical factor that might impede adequate dilution of local anesthetic and explain the development of cauda equine syndrome and transitory radicular irritation. Methods: The spinal dura matters and their contents from two male human cadavers were examined after organs had been extracted for transplantation. Both men had recently died at ages 56 and 65 years of age. Samples were f...
Lidocaine in the horse: its pharmacological effects and their relationship to analytical findings.
Journal of veterinary pharmacology and therapeutics    January 14, 1999   Volume 21, Issue 6 462-476 doi: 10.1046/j.1365-2885.1998.00165.x
Harkins JD, Mundy GD, Woods WE, Lehner A, Karpiesiuk W, Rees WA, Dirikolu L, Bass S, Carter WG, Boyles J, Tobin T.Lidocaine is a local anaesthetic agent that is widely used in equine medicine. It is also an Association of Racing Commissioners International (ARCI) Class 2 foreign substance that may cause regulators to impose substantial penalties if residues are identified in post race urine samples. Therefore, an analytical/pharmacological database was developed for this drug. Using our abaxial sesamoid local anaesthetic model, the highest no-effect dose (HNED) for the local anaesthetic effect of lidocaine was determined to be 4 mg. Using enzyme-linked immunosorbent assay (ELISA) screening, administration...
Effect of intravenous lidocaine on halothane minimum alveolar concentration in ponies.
Equine veterinary journal    August 15, 1998   Volume 30, Issue 4 300-303 doi: 10.1111/j.2042-3306.1998.tb04101.x
Doherty TJ, Frazier DL.This study investigated the effect of lidocaine i.v. on halothane minimum alveolar concentration (MAC) in ponies. Six ponies were anaesthetised with thiopentone and succinylcholine, intubated and anaesthesia maintained with halothane. Ventilation was controlled and blood pressure maintained within clinically acceptable limits. Following a 2 h equilibration period, baseline halothane MAC was determined. The ponies were then given a loading dose of lidocaine (2.5 or 5 mg/kg bwt) or saline over 5 min, followed by a constant infusion of lidocaine (50 or 100 microg/kg/min, or saline, respectively)....
Effects of local anesthetics on Na+ channels containing the equine hyperkalemic periodic paralysis mutation.
The American journal of physiology    August 4, 1998   Volume 275, Issue 2 C389-C400 doi: 10.1152/ajpcell.1998.275.2.C389
Sah RL, Tsushima RG, Backx PH.We examined the ability of local anesthetics to correct altered inactivation properties of rat skeletal muscle Na+ channels containing the equine hyperkalemic periodic paralysis (eqHPP) mutation when expressed in Xenopus oocytes. Increased time constants of current decay in eqHPP channels compared with wild-type channels were restored by 1 mM benzocaine but were not altered by lidocaine or mexiletine. Inactivation curves, which were determined by measuring the dependence of the relative peak current amplitude after depolarization to -10 mV on conditioning prepulse voltages, could be shifted in...
[Use of a mix of lidocaine and butorphanol as a caudal epidural anesthesia in a mare].
Canadian journal of veterinary research = Revue canadienne de recherche veterinaire    October 1, 1996   Volume 60, Issue 4 288-295 
Csik-Salmon J, Blais D, Vaillancourt D, Garon O, Bisaillon A.Loss of rear motor control is the main limiting factor in the use of caudal epidural anesthesia in the horse. In man and laboratory animals, a small dose of an opiate combined with a local anesthetic enhances analgesia without impairing motor function. Thus, the amount of local anesthetic administered may be reduced. Butorphanol is an opiate widely used in horses. It has a good margin of safety and few cardiorespiratory effects. The effects of lidocaine (0.25 mg/kg) and lidocaine-butorphanol (0.25 mg/kg, and 0.04 mg/kg, respectively) were compared in 2 groups of 5 healthy unsedated mares. Hors...
Regulatory significance of procaine residues in plasma and urine samples: preliminary communication.
Equine veterinary journal    March 1, 1996   Volume 28, Issue 2 121-125 doi: 10.1111/j.2042-3306.1996.tb01603.x
Harkins JD, Mundy GD, Stanley S, Woods WE, Boyles J, Arthur RA, Sams RA, Tobin T.Plasma and urinary concentrations of procaine and the duration of response to procaine after its administration as a local anaesthetic to horses were studied. Following injection of a clinical dose of procaine HCl (80 mg), the concentration of procaine in plasma was less than the lower limit of quantitation and unsuitable for threshold determination. Therefore, the urinary concentration of procaine was determined after injection of a dose of 5 mg procaine HCl, the highest no-effect dose (HNED) of this agent. Free unconjugated procaine in equine urine reached a peak concentration of 23.7 ng/mL,...
Pharmacokinetics of lignocaine in Icelandic horses after infiltration anaesthesia.
The Veterinary record    February 3, 1996   Volume 138, Issue 5 111-112 doi: 10.1136/vr.138.5.111
Kristinsson J, Thordarson TH, Johannesson T.The pharmacokinetics of lignocaine was studied in four Icelandic horses after infiltration anaesthesia. A total of 240 mg of the drug was injected on either side of the left foreleg, over the medial and lateral branches of the palmar nerve. Blood samples were collected up to seven hours after injection and the concentrations of the drug in plasma were determined by gas chromatography/mass spectrometry. The results showed that lignocaine was rapidly absorbed. A mean maximum concentration of 232 ng/ml was observed after 20 minutes. In three of the horses the decline in the plasma concentration o...
Complication after the use of a combination of lignocaine and xylazine for epidural anaesthesia in a mare.
Australian veterinary journal    September 1, 1995   Volume 72, Issue 9 354-355 doi: 10.1111/j.1751-0813.1995.tb07543.x
Chopin JB, Wright JD.No abstract available
Ventricular tachycardia and myocardial dysfunction in a horse.
Journal of the American Veterinary Medical Association    December 1, 1994   Volume 205, Issue 11 1569-1573 
Traub-Dargatz JL, Schlipf JW, Boon J, Ogilvie GK, Bennett DG, Wingfield WE, Hutchison JM.Ventricular tachycardia develops less frequently than supraventricular dysrhythmias and generally is more indicative of cardiac disease. The horse in this report had clinical signs of lethargy and hypophagia and was determined to have sustained ventricular tachycardia. Echocardiography was a valuable diagnostic tool and revealed an echodense area in the left ventricle that had subnormal ventricular performance. A primary heart problem of an inflammatory nature was suspected. The horse responded favorably to treatment with lidocaine, antimicrobials, and aspirin, as well as stall rest. The horse...
Narcotics and local anesthetics.
The Veterinary clinics of North America. Equine practice    December 1, 1993   Volume 9, Issue 3 605-620 doi: 10.1016/s0749-0739(17)30388-7
Kamerling SG.The recognition and alleviation of animal pain is a growing veterinary and public concern. Pain can be of an acute or chronic nature with different behavioral manifestations. Physiologically, pain is a dynamic and complex phenomenon that produces changes in the central and autonomic nervous systems as well as in the endocrine system. Horses and other animals appear to possess an endogenous pain-suppressing system involving the brainstem and spinal cord. This system can modulate pain perception and the responses to it. The recently discovered endogenous opioid peptides (endorphins and enkephali...
Paravertebral thoracolumbar anaesthesia in 10 horses.
Equine veterinary journal    July 1, 1993   Volume 25, Issue 4 304-308 doi: 10.1111/j.2042-3306.1993.tb02968.x
Moon PF, Suter CM.The caudal border of the last rib was used as a reliable point of orientation while performing paravertebral thoracolumbar anaesthesia (PTLA) on 10 horses undergoing standing flank laparotomy. The local anaesthetic in all horses was 2% lidocaine. The PTLA procedure was completed in 9.8 +/- 1.8 mins (mean +/- sd). Sedation was provided by a combination of intravenous morphine with xylazine or detomidine. Overall analgesia, provided by the combination of PTLA and sedation, was rated as excellent in 2 horses and good in 6 horses. In the remaining 2 horses, overall analgesia was rated as fair beca...
Comparison of lidocaine, xylazine, and xylazine/lidocaine for caudal epidural analgesia in horses.
Journal of the American Veterinary Medical Association    October 15, 1992   Volume 201, Issue 8 1187-1190 
Grubb TL, Riebold TW, Huber MJ.Caudal epidural analgesia was achieved in 6 adult horses on 3 successive occasions at weekly intervals by injection of lidocaine, xylazine, and a combination of lidocaine/xylazine through indwelling epidural catheters. Analgesia was defined as a lack of response to pinprick and hemostat pressure in the skin of the perineal area. A significant (P < 0.05) difference was not found for time of onset of analgesia between lidocaine (4.3 +/- 0.8 minutes, mean +/- SEM) and the lidocaine/xylazine combination (5.3 +/- 1.3 minutes). Time to onset of analgesia after administration of xylazine was signi...
The pharmacology of local anesthetics.
The Veterinary clinics of North America. Equine practice    December 1, 1991   Volume 7, Issue 3 489-500 doi: 10.1016/s0749-0739(17)30482-0
Day TK, Skarda RT.Understanding of the pharmacology of local anesthesia is important for selection of a local anesthetic for use in equine standing surgery. In general, the action potential is inhibited by local anesthetics by preventing the influx of sodium ions across the axonal membrane. The physicochemical properties of each local anesthetic determine the onset of action, potency, and duration of action. Procaine, chlorprocaine, lidocaine, and mepivacaine are the local anesthetics still used clinically in horses; lidocaine is the most widely used. The future of equine local anesthesia may see the introducti...
A preliminary comparison of lidocaine and xylazine as epidural analgesics in ponies.
Veterinary surgery : VS    January 1, 1989   Volume 18, Issue 1 85-86 doi: 10.1111/j.1532-950x.1989.tb01046.x
Fikes LW, Lin HC, Thurmon JC.Xylazine (0.35 mg/kg) or lidocaine (0.35 mg/kg) was injected into the epidural space of six ponies to compare their effectiveness as epidural analgesics. Each pony received both treatments at 1 week intervals with the order of treatments randomized. Xylazine produced analgesia of significantly longer duration (247 +/- 58 minutes) than that produced by an equal dose of lidocaine (135 +/- 22 minutes). Mild transient ataxia of no clinical significance developed in all ponies with both treatments. Spinal cords were removed from two ponies and examined histologically. No discernible pathologic chan...
Changes in equine carpal joint synovial fluid in response to the injection of two local anesthetic agents.
The Cornell veterinarian    January 1, 1989   Volume 79, Issue 1 25-38 
White KK, Hodgson DR, Hancock D, Parry BW, Cordell C.The effects of repeated arthrocentesis and injection of local anesthetic agents, lidocaine HCl or mepivacaine HCl on the equine middle carpal joint were investigated. Synovial fluid samples were evaluated before, and 12, 24 and 48 hours following, treatment. The greatest changes from pretreatment values occurred in synovial fluid cellularity. Repeated arthrocentesis caused a moderate increase in cell counts, while injection of local anesthetics caused a greater increase. Alterations in mucin clot quality, hyaluronic acid content, fluid viscosity, total protein and immunoglobulin G were general...
Epidural injection of xylazine for perineal analgesia in horses.
Journal of the American Veterinary Medical Association    December 1, 1988   Volume 193, Issue 11 1405-1408 
LeBlanc PH, Caron JP, Patterson JS, Brown M, Matta MA.Local anesthetics given in the epidural space of a horse may cause hind limb weakness in addition to analgesia. Because alpha 2 agonists given by epidural injection cause sensory blockade without motor effects in human beings and other species, their use in veterinary anesthesia is appealing. This study was designed to examine the effectiveness of xylazine HCl, an alpha 2 agonist commonly used in horses. Xylazine, 0.9% NaCl, and lidocaine were given by epidural injection to horses subjected to perineal electrical stimulation. Administration of xylazine (0.17 mg/kg of body weight, diluted to a ...
Evaluation of the potential for interference by dimethyl sulfoxide (DMSO) in drug detection in racing animals.
Journal of veterinary pharmacology and therapeutics    December 1, 1987   Volume 10, Issue 4 298-304 doi: 10.1111/j.1365-2885.1987.tb00105.x
Craig AM, Blythe LL, Appell LH, Slizeski ML.Dimethyl sulfoxide (DMSO) had been postulated to be a 'masking agent' when used concurrently with therapeutic or prohibited drugs in racing animals. Eight drugs (flunixin, furosemide, caffeine, apomorphine, phenylbutazone, lidocaine, cocaine, and acepromazine maleate) were administered to six horses singly and with concurrent intravenous DMSO. Urine samples were analyzed for the presence of the drugs and/or their metabolites by thin layer chromatography. Direct comparison of thin layer chromatograms of extracts of positive urine samples with and without DMSO verified that DMSO did not interfer...
Plasma lidocaine concentrations in conscious horses after cervicothoracic (stellate) ganglion block with 1% lidocaine HCl solution.
American journal of veterinary research    July 1, 1987   Volume 48, Issue 7 1092-1097 
Skarda RT, Muir WW, Couri D.Arterial and/or central venous plasma concentrations of lidocaine were determined in 12 nonmedicated adult horses (422 +/- 59 kg of body weight, mean +/- SD) after injecting a 1% lidocaine HCl solution into the cervicothoracic ganglion (CTG). A mean dosage of 2.9 +/- 0.5 mg of lidocaine/kg of body weight was used to induce unilateral CTG blockade in 8 horses and 4.8 +/- 0.8 mg was used to induce bilateral CTG blockade in 4 horses. Blood samples were collected before and at 5, 15, 30, 45, 60, 75, 90, 105, and 120 minutes after injection. The plasma lidocaine concentrations were determined by us...
Cardiovascular drugs. Their pharmacology and use in horses.
The Veterinary clinics of North America. Equine practice    April 1, 1987   Volume 3, Issue 1 37-57 doi: 10.1016/s0749-0739(17)30690-9
Muir WW, McGuirk S.Knowledge of the dosage, rate and route of administration, and potential side effects of drugs used to treat cardiac disease in horses has been refined. The judicious use of these drugs can increase exercise capacity, improve health, and potentially prolong life. Currently, antiarrhythmics (quinidine, lidocaine), positive inotropies (digoxin), and diuretics (furosemide) are the primary agents used to treat cardiovascular disease in horses. The development of newer drugs (verapamil, milrinone, bumetanide) and their usefulness in therapy for horses with cardiovascular disease require further inv...
Pharmacokinetics of antipyrine, acetaminophen and lidocaine in fed and fasted horses.
Journal of veterinary pharmacology and therapeutics    March 1, 1987   Volume 10, Issue 1 73-82 doi: 10.1111/j.1365-2885.1987.tb00079.x
Engelking LR, Blyden GT, Lofstedt J, Greenblatt DJ.Previous studies demonstrated that plasma clearance of organic anions such as bilirubin, bile acid, sulfobromophthalein (BSP) and indocyanine green (ICG), was reduced from 36% (bile acid) to 55% (ICG) in fasted (3 days) horses. It is believed that a general decline in carrier-mediated hepatic uptake may have accounted for those changes. However, fasting may also affect hepatic blood flow, thereby contributing to reduced clearance of these compounds. In order to test this hypothesis, plasma clearance of antipyrine, acetaminophen and lidocaine, drugs known to be cleared by the liver yet not susp...
Antipyrine and lidocaine are cleared faster in horses than in humans: acetaminophen may be handled similarly.
Pharmacology    January 1, 1987   Volume 34, Issue 4 192-200 doi: 10.1159/000138269
Engelking LR, Lofstedt J, Blyden GT, Greenblatt DJ.The following studies were designed to evaluate plasma elimination kinetics of intravenously administered antipyrine, acetaminophen and lidocaine among 9 healthy adult horses and 9 healthy drug-free humans (3 each per drug group), in order to compare potential species differences in drug-metabolizing ability. Acetaminophen is largely biotransformed in humans by hepatic glucuronide and sulfate conjugation, whereas both antipyrine and lidocaine are oxidized by hepatic microsomal mixed-function oxidases. Thus, plasma clearances of these drugs are thought to reflect differences in hepatic oxidativ...