Which amide local anesthetic is metabolized in both the liver and the lungs?

The amide local anesthetic that is metabolized in both the liver and the lungs is articaine. Unlike most amides, which are primarily metabolized in the liver, articaine also undergoes hydrolysis in the plasma and is partially metabolized in the lungs. This unique property enhances its effectiveness and reduces systemic toxicity.

Prilocaine is primarily metabolized in the liver and can produce metabolites that lead to methemoglobinemia in some cases, but it doesn't have the same dual metabolism route as articaine. Mepivacaine and procaine are also primarily metabolized in the liver; however, procaine is an ester, not an amide, and thus has a different metabolic pathway entirely.

This distinction makes articaine particularly advantageous in certain clinical scenarios, as its rapid metabolism can help minimize systemic side effects and allow for faster recovery from anesthesia. This understanding is essential for anesthesiologists in selecting appropriate local anesthetics for various procedures.