Gaumann D M, Tassonyi E, Fathi F, Griessen M
Department of Anesthesiology, University Hospital Geneva, Switzerland.
ORL J Otorhinolaryngol Relat Spec. 1992;54(1):49-53. doi: 10.1159/000276259.
The sympathetic response to rigid bronchoscopy, laryngoscopy and esophagoscopy, performed under general anesthesia with isoflurane, was examined in patients who either received 5 ml of 2% lidocaine (n = 7) or 5 ml of saline (n = 7), sprayed on larynx and upper trachea under direct laryngoscopy, 2 min before the introduction of the rigid bronchoscope. Blood pressure, heart rate and plasma catecholamine and lidocaine levels were measured at specific time points of the study. Topical lidocaine led to a rapid and prolonged increase in plasma lidocaine levels. Patients treated with lidocaine showed a small but significant decrease in plasma epinephrine levels from baseline following endotracheal intubation and extubation, as compared to the saline control group. Blood pressure and heart rate response during rigid panendoscopy, isoflurane requirements and time interval from termination of panendoscopy to extubation were not different between the two groups. However, in contrast to the control group, patients who had received lidocaine had no significant rise in blood pressure and heart rate from baseline following the introduction of the rigid bronchoscope. The benefit of this moderate hemodynamic stabilizing effect of lidocaine has to be weighted against the risk of decreased protective airway reflexes due to topical laryngeal lidocaine during recovery from anesthesia.
在全身麻醉下使用异氟烷进行硬质支气管镜检查、喉镜检查和食管镜检查时，对两组患者的交感神经反应进行了研究。一组（n = 7）患者在直接喉镜检查下于插入硬质支气管镜前2分钟，在喉部和气管上部喷洒5毫升2%利多卡因，另一组（n = 7）患者喷洒5毫升生理盐水。在研究的特定时间点测量血压、心率、血浆儿茶酚胺和利多卡因水平。局部使用利多卡因导致血浆利多卡因水平迅速且持续升高。与生理盐水对照组相比，使用利多卡因治疗的患者在气管插管和拔管后血浆肾上腺素水平较基线有小幅但显著的下降。两组在硬质全内镜检查期间的血压和心率反应、异氟烷需求量以及从全内镜检查结束到拔管的时间间隔方面没有差异。然而，与对照组不同的是，接受利多卡因治疗的患者在插入硬质支气管镜后血压和心率较基线没有显著升高。利多卡因这种适度的血流动力学稳定作用的益处必须与麻醉恢复期间由于局部喉部利多卡因导致气道保护性反射降低的风险相权衡。
