Enlund M, Mentell O, Krekmanov L
Department of Anaesthesia & Intensive Care, Centre for Clinical Research, Central Hospital, Västerås, Sweden.
Acta Anaesthesiol Scand. 2001 Mar;45(3):294-7. doi: 10.1034/j.1399-6576.2001.045003294.x.
A probable causal relationship between submucosal infiltration of lidocaine, with adrenaline 12.5 microg x mL(-1), and untoward arterial hypotension during general anaesthesia for orthognathic surgery was investigated in two parts.
The first part of the study was open and non-randomised. The patients served as their own controls, receiving 5.4 mL saline/adrenaline before mandibular or maxillary surgery on the first side of the jaw and 5.4 mL lidocaine (2%)/adrenaline on the other side a minimum of 40 min later. Nine patients received in total 11 pairs of injections of the study drugs. In Part Two, 50 mg or 100 mg of lidocaine with adrenaline was infiltrated in an observer-blinded and randomised order in either side of the jaw in another 13 patients.
A significant and dose-dependent blood pressure decrease was observed after infiltration of lidocaine/adrenaline, but not after saline/adrenaline. The heart rate increased significantly after both types of injections, most pronounced after saline/adrenaline. Mean arterial blood pressure decreased on average 11% and 23% with lidocaine 50 mg and 100 mg, respectively (P<0.05, ANOVA).
Lidocaine induced dose-dependent arterial hypotension when combined with a defined level of general anaesthesia. The causative mechanism is unclear.
分两部分研究了在正颌外科全身麻醉期间，黏膜下注射含12.5μg/mL肾上腺素的利多卡因与不良动脉低血压之间可能的因果关系。
研究的第一部分为开放性非随机研究。患者自身作为对照，在下颌或上颌手术时，先在一侧颌骨注射5.4mL生理盐水/肾上腺素，至少40分钟后在另一侧注射5.4mL利多卡因（2%）/肾上腺素。9例患者共接受了11对研究药物注射。在第二部分中，另外13例患者以观察者盲法和随机顺序在颌骨两侧分别注射50mg或100mg利多卡因加肾上腺素。
注射利多卡因/肾上腺素后观察到血压显著且呈剂量依赖性下降，但注射生理盐水/肾上腺素后未出现此情况。两种注射后心率均显著增加，注射生理盐水/肾上腺素后最为明显。利多卡因50mg和100mg时，平均动脉血压分别平均下降11%和23%（方差分析，P<0.05）。
利多卡因与特定水平的全身麻醉联合使用时会引起剂量依赖性动脉低血压。其致病机制尚不清楚。
