Wieczorek P M, Schricker T, Vinet B, Backman S B
Department of Anaesthesia, McGill University Health Center - Royal Victoria Hospital Site, 687 Pine Ave. W., Montreal, QC, H3A 1A1, Canada.
Anaesthesia. 2007 Oct;62(10):984-8. doi: 10.1111/j.1365-2044.2007.05179.x.
We evaluated the technique of airway anaesthesia using atomised lidocaine for awake oral fibreoptic intubation in morbidly obese patients using two doses of local anaesthetic. Morbidly obese patients were allocated to receive either 2% or 4% lidocaine (40 ml) for oral airway anaesthesia using an atomiser with high oxygen flow. Patients were carefully sedated using midazolam and fentanyl. Outcomes included patient tolerance to airway manipulation, haemodynamic parameters, and serial plasma lidocaine concentrations. In all, 27 patients were enrolled in the study (2% cohort n = 14, 4% cohort n = 13). Patient characteristics and time for topicalisation and airway management were similar. Haemodynamic parameters did not change significantly. Tolerance to insertion of the Ovassapian airway, bronchoscopy, and tracheal tube positioning was excellent (12 vs 12 patients, 12 vs 12 patients, and 8 vs 12 patients had no response, respectively, 2% vs 4%). Differences did not reach statistical significance. Peak plasma lidocaine concentration was significantly lower in the 2% group (2.8 (0.8) microg.ml(-1) compared with 6.5 (1.0) microg.ml(-1), p < 0.05). Airway anaesthesia using atomised lidocaine for awake fibreoptic intubation in the morbidly obese is efficacious, rapid, and safe. Compared with 4% lidocaine, the 2% dose provides acceptable intubating conditions in most cases and produces lower plasma lidocaine levels.
我们使用两种剂量的局部麻醉药，评估了雾化利多卡因用于病态肥胖患者清醒口腔纤维光导插管气道麻醉的技术。病态肥胖患者被分配接受2%或4%的利多卡因（40毫升），使用高氧流量雾化器进行口腔气道麻醉。患者使用咪达唑仑和芬太尼进行仔细镇静。结果包括患者对气道操作的耐受性、血流动力学参数和系列血浆利多卡因浓度。总共27名患者纳入研究（2%组n = 14，4%组n = 13）。患者特征以及局部麻醉和气道管理的时间相似。血流动力学参数没有显著变化。对插入奥瓦萨皮安气道、支气管镜检查和气管导管定位的耐受性极佳（分别为2%组与4%组，无反应的患者数为12比12、12比12和8比12）。差异未达到统计学显著性。2%组的血浆利多卡因峰值浓度显著更低（2.8（0.8）微克·毫升⁻¹，相比之下4%组为6.5（1.0）微克·毫升⁻¹，p < 0.05）。雾化利多卡因用于病态肥胖患者清醒纤维光导插管的气道麻醉是有效、快速且安全的。与4%利多卡因相比，2%剂量在大多数情况下能提供可接受的插管条件，并产生更低的血浆利多卡因水平。
