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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (5): 890-895. doi: 10.19723/j.issn.1671-167X.2024.05.021

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Effects of unilateral thoracic paravertebal block on hemodynamic and the level of conscionsness during double lumen endotracheal intubation

Jun WANG1, Lan YAO1, Ning ZHANG1, Libin SUO1, Hongpei LI1, Yue WEI1, Peng CHA2, Zheng LIANG2, Kunpeng LIU1,*()   

  1. 1. Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
    2. Department of Thoracic Surgery, Peking University International Hospital, Beijing 102206, China
  • Received:2021-12-02 Online:2024-10-18 Published:2024-10-16
  • Contact: Kunpeng LIU E-mail:liukunpeng@pkuih.edu.cn

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Abstract:

Objective: To compare the effects of unilateral thoracic paravertebal block with lidocaine on hemodynamic and the level of consciousness during double lumen endotracheal intubation. Methods: From June to october 2021, a total of 40 patients American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ, aged 19-65 years, scheduled for elective thoracic sugeries in Peking University International Hospital block with under general anesthesia requiring orotracheal intubation were recruited and divided into two groups: The double-lumen endobronchial intubation (group C) and double-lumen endobronchial intubation after thoracic paravertebal block with lidocaine (group P). After an intravenous anesthetic induction, the orotracheal double-lumen intubation was performed using a Macintosh direct laryngoscopy, respectively. Invasive blood pressure (BP) and heart rate (HR) were recorded before and after anesthetic induction, immediately after intubation and 5 min after intubation with 1-minute interval and the intubation time was also noted. Rate-pressure product (RPP) were calculated. Results: After anesthetic induction, BP and RPP in the two groups decreased significantly compared with their preinduction values. As comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in BP, HR and RPP. Diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased significantly and lasted for 1-minute in group C compared with the baseline values. Systolic blood pressure (SBP) was not significant change and DBP increased significantly immediately after intubation in group P.HR of both groups after intubation were significantly higher than their baseline values and lasted for 4 min in group C, HR increased significantly immediately after intubation in group P. SBP, DBP, MAP, HR and RPP after intubation in group P were significantly lower than those of group C during the observation period. The value of BIS was similar between the two groups. Compared with group C, the incidence of SBP greater than 30% and RPP greater than 22 000 was significantly lower in group P in the observation period, and no patient in group P developed RPP greater than 22 000. At the end of the incidence of SBP less than 30% of the basal value and HR less than 30% of the baseline, no severe bradycardia occurred in both groups. Conclusion: During double-lumen endobronchial intubation, unilateral thoracic paravertebal block with lidocaine can provide less hemodynamic response and level of conscionsness.

Key words: Intubation, intratachea, Lidocaine, Hemodynamics, Aesthesia, general, Paravertebral block

CLC Number: 

  • R614

Table 1

Demographic characteristics of the two groups"

Items Group C(n＝20) Group P(n＝20)
Gender，femail/male 5/15 10/10
Age/years，${\bar x}$±s 42.7±16.5 51.6±11.9
Height/cm，${\bar x}$±s 166.8±8.6 165.8±8.4
Weight/kg，${\bar x}$±s 63.0±9.2 62.4±9.7
Type of tube，left/right 12/8 17/3
Model of tube，35/37/39 3/8/9 4/9/7
Intubation time/s，${\bar x}$±s 44.8±16.6 47.9±11.5

Table 2

Comparative changes in hemodynamics between the two groups"

Variables Group Baseline Post-ID Immiedeately After IT/min Maximal values
1 2 3 4 5
SBP/mmHg C 143±14 96±19* 155±39# 161±41# 138±38# 126±33*# 121±28*# 115±27*# 181±40*#
P 141±11 96±16* 139±22# 123±22*#☆ 107±18*#☆ 101±16*☆ 97±16*☆ 95±16*☆ 150±23#☆
DBP/mmHg C 74±9 56±11* 94±25*# 93±21*# 83±21# 77±20# 74±20# 72±19# 111±19*#
P 74±9 55±9* 84±14# 69±11#☆ 61±9*#☆ 57±8*☆ 56±8*☆ 55±9*☆ 87±15*#☆
MAP/mmHg C 97±9 69±12* 114±29*# 116±24*# 101±24# 94±21# 89±18# 86±18*# 134±24*#
P 96±6 69±11* 103±16# 87±14*#☆ 76±118*#☆ 72±10*☆ 70±11*☆ 68±11*☆ 108±17*#☆
HR/(/min) C 82±14 78±15 105±17*# 103±15*# 97±16*# 95±16*# 93±16.7*# 90±16# 117±18*#
P 77±10 69±10*☆ 92±16*#☆ 81±14#☆ 79±15#☆ 77±13#☆ 77±12#☆ 75±12☆ 98±17*#☆
BIS C 96±2 24±6* 26±4*# 29±7*# 31±9*# 35±9*# 41±10*# 47±13*# 47±13*#
P 94±4 24±8* 27±7* 30±11*# 34±11*# 36±13*# 38±12*# 41±12*# 42±12*#
RPP C 11 660±2 055 7 426±1 905* 16 365±5 101*# 16 433±4 415*# 13 318±4 279# 11 968±3 732# 11 144±3 105# 10 392±2 972# 21 062±5 487*#
P 10 887±2 055 6 616±1 398*☆ 12 959±3 452*#☆ 9 993±2 496#☆ 8 485±2 104*#☆ 7 833±1 840*#☆ 7 421±1 741*☆ 7 087±16 230*☆ 14 743±3 665*#☆

Table 3

The incidences of SBP and HR more than 130% of baseline value and RPP more than 22 000"

Items Group C Group P
% n % n
SBP+30% baseline 45 9 15* 3
SBP-30% baseline 30 6 60 12
HR+30% baseline 65 13 25* 5
HR-30% baseline 0 0 5 1
RPP>22 000 50 10 0* 0
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