Effects of thoracic epidural anesthesia on hemodynamic changes during tracheal intubation

다국어 초록 (Multilingual Abstract)

Background: We sought to assess whether increasing a single dose of 1.5% lidocaine during thoracic epidural anesthesia (TEA) could suppress hemodynamic responses after laryngoscopy and tracheal intubation.
Methods: A total of 81 patients (ASA physical status I and II, aged 45−75) who scheduled for major abdominal surgery were enrolled. Patients were randomly assigned to three groups, for epidural injection of different amounts of 1.5% lidocaine: 0.1 ml/kg (L0.1, n = 27), 0.2 ml/kg (L0.2, n = 27), and 0.3 ml/kg (L0.3, n = 27). After 15 min, general anesthesia was induced with intravenous thiopental sodium (5 mg/kg) and rocuronium (0.9 mg/kg), followed by tracheal intubation. Changes in blood pressure and heart rate were recorded for 3 min after intubation. Maximum percentage increases in systolic blood pressure (SBP) during the 3 min after tracheal intubation from baseline and the induction value were compared.
Results: The maximum increases in SBP from baseline values were significantly higher in L0.1 than in L0.2 and L0.3 (22.6%; 95% CI, 12.2−33.0%; -0.5%; 95% CI, -11.1−10.0%; and -6.9%; 95% CI, -13.9−0.0%, respectively), whereas the maximum increases from induction values did not differ significantly.
Conclusions: Preoperative TEA using a single dose of 1.5% lidocaine at 0.2 ml/kg attenuated hemodynamic responses during tracheal intubation but did not completely suppress blood pressure reactions to laryngoscopy and tracheal intubation.

참고문헌 (Reference)

1 Brull SJ, "Zones of differential sensory block during extradural anaesthesia" 66 : 651-655, 1991

2 Curatolo M, "Zbinden AM, Scaramozzino P, Venuti FS: A multifactorial analysis of the spread of epidural analgesia" 38 : 646-652, 1994

3 Wattwil M, "Thoracolumbar epidural anaesthesia blocks the circulatory response to laryngoscopy and intubation" 31 : 529-531, 1987

4 Yokoyama M, "The effects of epidural insertion site and surgical procedure on plasma lidocaine concentration" 92 : 470-475, 2001

5 Peters J, "Sympathetic blockade by epidural anesthesia attenuates the cardiovascular response to severe hypoxemia" 72 : 134-144, 1990

6 Stjernberg L, "Sympathetic activity in man after spinal cord injury. Outflow to muscle below the lesion" 109 : 695-715, 1986

7 Erdemir HA, "Studies of factors affecting peridural anesthesia" 44 : 400-405, 1965

8 Ko SH, "Small-dose fentanyl: optimal time of injection for blunting the circulatory responses to tracheal intubation" 86 : 658-661, 1998

9 Cederholm I, "Sensory, motor, and sympathetic block during epidural analgesia with 0.5% and 0.75% ropivacaine with and without epinephrine" 19 : 18-33, 1994

10 Chraemmer-Jorgensen B, "Lack of effect of intravenous lidocaine on hemodynamic responses to rapid sequence induction of general anesthesia: A double-blind controlled clinical trial" 65 : 1037-1041, 1986

11 Miller CD, "I.v. lignocaine fails to attenuate the cardiovascular response to laryngoscopy and tracheal intubation" 65 : 216-219, 1990

12 Magnusdottir H, "High thoracic epidural anesthesia does not inhibit sympathetic nerve activity in the lower extremities" 1299-1304, 1999

13 Takahashi S, "Hemodynamic responses to tracheal intubation with laryngoscope versus lightwand intubating device (Trachlight) in adults with normal airway" 95 : 480-484, 2002

14 Nakatani T, "Haemodynamic effects of thoracic epidural anaesthesia during induction of anaesthesia: An investigation into the effects of tracheal intubation during target-controlled infusion of propofol" 60 : 530-534, 2005

15 Curatolo M, "Factors associated with hypotension and bradycardia after epidural blockade" 83 : 1033-1040, 1996

16 Duggan J, "Extradural block with bupivacaine: Influence of dose, volume, concentration and patient characteristics" 61 : 324-331, 1988

17 Grundy EM, "Extradural analgesia revisited. A statistical study" 50 : 805-809, 1978

18 Hodgson PS, "Epidural lidocaine decreases sevoflurane requirement for adequate depth of anesthesia as measured by the Bispectral Index monitor" 94 : 799-803, 2001

19 Montes FR, "Endotracheal intubation with a lightwand or a laryngoscope results in similar hemodynamic variations in patients with coronary artery disease" 50 : 824-828, 2003

20 Block BM, "Efficacy of postoperative epidural analgesia: a meta- analysis" 290 : 2455-2463, 2003

21 Stevens RA, "Does spinal anesthesia result in a more complete sympathetic block than that from epidural anesthesia?" 82 : 877-883, 1995

22 Hodgson PS, "Does epidural anesthesia have general anesthetic effects?: A prospective, randomized, double- blind, placebo-controlled trial" 91 : 1687-1692, 1999

23 Stoelting RK, "Circulatory changes during direct laryngoscopy and tracheal intubation: Influence of duration of laryngoscopy with or without prior lidocaine" 47 : 381-384, 1977

24 Stevens RA, "Changes in human plasma catecholamine concentrations during epidural anesthesia depend on the level of block" 74 : 1029-1034, 1991

25 Licker M, "Cardiovascular reflexes during anesthesia induction and tracheal intubation in elderly patients: The influence of thoracic epidural anesthesia" 7 : 281-287, 1995

26 Veering BT, "Cardiovascular and pulmonary effects of epidural anaesthesia" 28 : 620-635, 2000