This paper was presented in September 1997 during a Round Table Discussion on lidocaine toxicity, held at the Nobel Forum, Karolinska Institute, Stockholm, Sweden. The occasion was in honor of Professor emeritus Torsten Gordh, who in August 1997 celebrated his 90th birthday. Torsten Gordh, also present at the Round Table Discussion, was the first anesthesiologist who used lidocaine clinically. Today, when some clinical problems with the intrathecal use of lidocaine are discussed, we are indeed fortunate to have Torsten Gordh still most vital and active in our midst.
Hans v. Euler, while investigating how genes and enzymes were chemically related in some chlorofylldefective mutants of barley, isolated gramine, an indole. Erdtman synthetized isogramine and found it to have weak anesthetic properties. He then together with Löfgren synthetized other amino-amides, but no one of them could compete with the existing local anesthetics of the ester-type, derivatives of para-aminobenzoic acid, e.g. procaine. Later Löfgren and Lundqvist followed up these studies and found an amid compound lidocaine (2-dimethylaminoacet-2, 6-xylidide). Lidocaine represented such a significant advance over procaine in clinical tests preformed by T. Gordh that it was introduced for clinical use. It has now during a half century been the standard local anesthetic drug. All local anesthetics are neurotoxic in high enough doses. Xylocain, however, has had an excellent record of safety. Only during the last years have there been reports on possible toxic irritation and damage by Xylocain used for spinal anesthesia. The aetiology is still not clear In this connection two early observations by Gordh and his coworkers are discussed.
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