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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (4): 742-747. doi: 10.19723/j.issn.1671-167X.2019.04.026

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Effects of thoracic epidural administration of lidocaine on hemodynamic and arousal responses of double lumen tracheal intubation during induction of anesthesia

Kun-peng LIU1,2,Bao-ning WANG2,Yan-yan SHEN2,Wei-xia LI1,Zhao LI1,Lan YAO2,△()   

  1. 1. Department of Anesthesiology, China-Japan Friendship Hospital, Beijing 100029,China
    2. Department of Anesthe-siology, Peking University International Hospital, Beijing 102206, China
  • Received:2017-07-26 Online:2019-08-18 Published:2019-09-03
  • Contact: Lan YAO E-mail:yaolan@pkuih.edu.cn

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Abstract:

Objective: To compare the effects of thoracic epidural administration of lidocaine on hemodynamic and arousal responses of double lumen tracheal intubation during induction of anesthesia. Me-thods: In the study, 40 patients with American Society of Anesthesiologists (ASA) physical statuses Ⅰ-Ⅱ,aged 19-66 years,scheduled for elective thoracic surgeries under general anesthesia requiring orotracheal intubation were allocated to either the double-lumen endobronchial intubation (T group) or double-lumen endobronchial intubation after epidural administration of lidocaine (E group). After an intravenous anesthetic induction, the orotracheal double-lumen intubation was performed using a Macintosh direct laryngoscopy (MDLS),respectively. Invasive blood pressure (BP),heart rate (HR) and bispectral index (BIS) were recorded before and after anesthetic induction,immediately after intubation and 5 minutes after intubation with 1-minute interval and the intubation time also noted. The rate pressure pro-duct (RPP) was calculated.Results: After anesthetic induction,BP and RPP in the two groups decreased significantly compared with their preinduction values. In comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in BPs, HRs and RPP. In comparison with their preinduction values, BPs decreased significantly in E group, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased significantly and lasted for 1 min in T group. The HRs of both groups after intubation were significantly higher than their baseline values,and increased in HR and lasted for 1 min and 4 min in E group and T group, respectively. SBP, DBP, MAP, HR and RPP after intubation in T group were significantly higher than those of E group during the observation period. The values of BIS were similar between both the groups. In T group, the incidences of SBP percent increased>30% of the baseline value and RPP more than 22 000 were significantly higher than in E group. None of the patients in group E had SBP more than 130% of the baseline value and RPP more than 22 000.Conclusion: During double-lumen endobronchial intubation, epidural administration of lidocaine can provide less hemodynamic response and similar arousal response.

Key words: Intubation, intratracheal, Lidocaine, Hemodynamics, Anesthesia, general, Anesthesia recovery period

CLC Number: 

  • R614.42

Table 1

Demographic characteristics of the two groups"

Items Group T (n=20) Group E (n=20)
Gender, Female/Male 5/15 4/16
Age/years, x?±s 51.5±15.0 53.8±9.5
Height/cm, x?±s 166.6±7.9 168.0±8.1
Weight/kg, x?±s 64.1±10.9 69.4±9.5
Type of tube, Left/Right 9/11 12/8
Intubation time/s, x?±s 46.0±16.6 49.0±11.9

Table 2

Comparative changes in hemodynamics between the two groups (x?±s, n=20)"

Variables Baseline Post-induction After intubation Maximal values
0 min 1 min 2 min 3 min 4 min 5 min
SBP/mmHg
Group T 146.3±13.3 98.4±19.5* 160.6±41.4# 165.4±39.7*# 139.8±36.6# 128.4±31.4*# 122.9±25.3*# 118.0±26.0*# 187.6±40.4*#
Group E 139.3.±13.8 86.7±13.6*☆ 112.9±20.0*#☆ 112.2±15.7*#☆ 101.8±12.7*#☆ 93.6±12.3*☆ 89.8±12.5*☆ 86.4±13.1*☆ 131.4±19.4#☆
DBP/mmHg
Group T 75.4±8.5 56.5±10.6* 94.8±25.3*# 93.2±21.6*# 83.0±21.1# 77.7±20.1# 74.0±19.6# 72.5±18.7# 112.3±17.9*#
Group E 71.9±8.6 48.0±7.0*☆ 67.3±14.2#☆ 63.7±8.4*#☆ 58.4±8.5*#☆ 54.2±8.2*#☆ 52.0±8.3*☆ 49.5±8.8*☆ 76.3±12.6#☆
MAP/mmHg
Group T 99.0±8.7 70.4±11.9* 116.7±30.1*# 117.3±23.8*# 101.9±22.6# 94.6±19.4# 90.3±16.9*# 87.6±16.2*# 137.4±22.9*#
Group E 94.3±9.0 60.9±8.8*☆ 82.5±15.9*#☆ 79.8±10.3*#☆ 72.9±9.6*#☆ 67.3±9.3*#☆ 64.6±9.4*☆ 61.8±10.0*☆ 94.7±14.1#☆
HR/(beats/min)
Group T 83.0±13.1 77.8±15.4 103.9±16.3*# 100.8±15.1*# 96.3±15.9*# 94.8±16.6*# 92.7±16.7*# 90.2±16.3# 114.8±16.5*#
Group E 78.7±9.8 72.0±10.8 82.0±14.3*#☆ 82.9±13.3*#☆ 80.6±12.4#☆ 79.0±12.4#☆ 77.6±12.5#☆ 76.2±13.1☆ 92.8±11.9*#☆
BIS
Group T 96.5±1.5 23.5±6.1* 27.6±6.3*# 30.1±8.6*# 32.2±10.1*# 36.8±10.5*# 40.4±12.1*# 45.0±13.4*# 46.3±12.4*#
Group E 97.1±0.9 23.4±6.4* 26.3±2.8* 27.5±5.9*# 31.6±9.6*# 35.1±11.9*# 37.1±12.9*# 39.0±11.9*# 42.4±9.8*#
RPP
Group T 121 00.0±
1 884.9		 7 601.4±
1 909.2*		 16 804.0±
5 469.7*#		 16 603.2±
4 452.3*#		 13 434.7±
4 190.6#		 12 123.5±
3 590.4#		 11 317.5±
2 921.3#		 10 595.8±
2 762.0#		 21 544.7±
5 522.9*#
GroupE 11 260.7±
1 610.1		 6 929.1±
1 557.8*		 9 428.5±
3 085.5#☆		 9 319.4±
2 149.7#☆		 8 259.5±
1 996.2*#☆		 7 449.2±
1 896.1*#☆		 7 013.5±
1 812.5*☆		 6 631.4±
1 825.8*☆		 12 245.1±
2 611.9*#☆

Table 3

The incidences of SBP and HR percent changes > 30% of baseline values and RPP > 22 000 during the observation in the two groups"

Items Group T Group E
SBP percent increase > 30% of baseline value 8 (40.0%) 0*
SBP percent decrease > 30% of baseline value 13 (65.0%) 15 (75.0%)
HR percent increase > 30% of baseline value 12 (60.0%) 6 (30.0%)
HR percent decrease > 30% of baseline value 0 1 (5.0%)
RPP> 22 000 11 (55.0%) 0*
[1] Gholipour BA, Firouzian A, Zamani KA , et al. Effect of etomi-date versus combination of propofol-ketamine and thiopental-ketamine on hemodynamic response to laryngoscopy and intubation: A randomized double blind clinical trial[J]. Anesth Pain Med, 2016,6(1):1-8.
[2] Choi BH, Lee YC . Effective bolus dose of sufentanil to attenuate cardiovascular responses in laryngoscopic double-lumen endobronchial intubation[J]. Anesth Pain Med, 2016,6(2):633-640.
[3] Thompson JP, West KJ, Hill AJ . The cardiovascular responses to double lumen endobronchial intubation and the effect of esmolol[J]. Anaesthesia, 1997,52(8):790-794.
[4] Selvaraj V, Manoharan KR . Prospective randomized study to compare between intravenous dexmedetomidine and esmolol for attenuation of hemodynamic to endotracheal intubation[J]. Anesth Essays Res, 2016,10(2):343-348.
[5] Yang W, Geng Y, Liu Y , et al. Comparison of effects of thoracic epidural and intravenous administration of lidocaine on target-controlled infusion of propofol and tracheal intubation response during induction of anesthesia[J]. J Cardiothorac Vasc Anesth, 2013,27(6):1295-1300.
[6] Buhari FS, Selvaraj V . Randomized controlled study comparing the hemodynamic response to laryngoscopy and endotracheal intubation with McCoy, Macintosh, and C-MAC laryngoscopes in adult patients[J]. J Anaesthesiol Clin Pharmacol, 2016,32(4):505-509.
[7] Maassen RL, Pieters BM, Maathuis B , et al. Endotracheal intubation using videolaryngoscopy causes less cardiovascular response compared to classic direct laryngoscopy, in cardiac patients according a standard hospital protocol[J]. Acta Anaesthesiol Belg, 2012,63(4):181-186.
[8] Mendonça FT, de Queiroz LM, Guimarães CC , et al. Effects of lidocaine and magnesium sulfate in attenuating hemodynamic response to trachealintubation: single-center, prospective, double-blind, randomized study[J]. Rev Bras Anestesiol, 2017,67(1):50-56.
[9] 薛富善 . 现代呼吸道管理学——麻醉与危重症治疗关键技术[M]. 郑州: 郑州大学出版社, 2002: 1020-1030.
[10] Yoo KY, Jeong CW, Kim WM , et al. Cardiovascular and arousal responses to single-lumen endotracheal and double-lumen endobronchial intubation in the normotensive and hypertensive elderly[J]. Korean J Anesthesiol, 2011,60(2):90-97.
[11] Hamaya Y, Dohi S . Differences in cardiovascular response to airway stimulation at different sites and blockade of the responses by lidocaine[J]. Anesthesiology, 2000,93(1):95-103.
[12] Mangano DT . Perioperative cardiac morbidity[J]. Anesthesiology, 1990,72(1):153-184.
[13] Kasaba T, Kondou O, Youshimura Y . Haemodynamic effects of induction of general anaesthesia with propofol during epidural anaesthesia[J]. Can J Anaesth, 1998,45(11):1061-1065.
[14] Nakatani T, Saito Y, Sakura S , et al. Haemodynamic effects of thoracic epidural anaesthesia during induction of anaesthesia: an investigation into the effects of tracheal intubation during target-controlled infusion of propofol[J]. Anaesthesia, 2005,60(6):530-534.
[15] 张励才 . 麻醉解剖学[M]. 北京: 人民卫生出版社, 2000: 317-320.
[16] Wacker JR, Wagner BK, Briese V , et al. Antihypertensive therapy in patients with pre-eclampsia: A prospective randomised multicentre study comparing dihydralazine with urapidil[J]. Eur J Obstet Gynecol Reprod Biol, 2006,127(2):160-165.
[17] Möller Petrun A, Kamenik M . Bispectral index-guided induction of general anaesthesia in patients undergoing major abdominal surgery using propofol or etomidate: a double-blind, randomized, clinical trial[J]. Br J Anaesth, 2013,110(3):388-396.
[18] Myles PS, Leslie K , McNeil J, et al. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial[J]. Lancet, 2004,363(9423):1757-1763.
[19] Kaada BR, Thomas F, Alnaes E , et al. EEG synchronization induced by high frequency midbrain reticular stimulation in anesthetized cats[J]. Electroencephalogr Clin Neurophysiol, 1967,22(3):220-230.
[20] Kissin I, Stanski DR, Brown PT , et al. Pentobarbital-morphine anesthetic interactions in terms of intensity of noxious stimulation required for arousal[J]. Anesthesiology, 1993,78(4):744-749.
[21] 张金华, 刘鲲鹏, 李成辉 , 等. 瑞芬太尼复合小剂量咪达唑仑用于ERCP监护性麻醉的研究[J]. 临床麻醉学杂志, 2012,28(7):39-42.
[22] 刘鲲鹏, 贾乃光, 赵诗斌 , 等. Shikani喉镜左侧磨牙入路和直接喉镜经口气管插管对血流动力学的影响[J]. 临床麻醉学杂志, 2010,26(9):744-747.
[23] Robinson BF . Relation of heart rate and systolic blood pressure to the onset of pain in angina pectoris[J]. Circulation, 1967,35(6):1073-1083.
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