Paulissian R, Salem M R, Joseph N J, Braverman B, Cohen H C, Crystal G J, Heyman H J
Department of Anesthesiology, Illinois Masonic Medical Center, Chicago 60657.
Anesth Analg. 1991 Jul;73(1):10-5. doi: 10.1213/00000539-199107000-00003.
After coronary artery bypass grafting (CABG) surgery, patients may remain at risk for myocardial ischemia and infarction and ventricular dysrhythmias. The hemodynamic responses to endotracheal extubation and the efficacy of intravenous lidocaine pretreatment were studied after CABG surgery and overnight mechanical ventilation. Twenty-five patients were divided into two groups: group 1 (n = 13) patients who had tracheal extubation after pretreatment with a placebo; group 2 patients who received lidocaine (1 mg/kg IV) before tracheal extubation. Hemodynamic data, electrocardiographic tracings, and arterial blood gases were obtained before tracheal extubation, during suctioning, and 1, 5, and 20 min after tracheal extubation. Group 1 patients displayed significant increases in heart rate, arterial blood pressure, rate-pressure product, right atrial pressure, and cardiac index during suctioning and within 1 min of tracheal extubation, returning to preextubation level by 5 min. There were no significant changes in pulmonary and systemic resistance indices. Hemodynamic changes in group 2 patients were similar to those in group 1. Both in the absence and presence of lidocaine, tracheal extubation caused hemodynamic responses that were small in magnitude and brief in duration. These responses were not associated with electrocardiographic or enzymatic evidence of myocardial ischemia or infarction, or with ventricular dysrhythmias. Compared with the well-documented hemodynamic responses to tracheal intubation, we found that extubation of the trachea after CABG surgery was associated with less pronounced responses. This may be related to avoidance of laryngoscopy and possibly accommodation to the endo-tracheal tube. These modest hemodynamic responses of extubation of the trachea after CABG surgery were not modified by intravenous lidocaine.
冠状动脉旁路移植术（CABG）后，患者仍有心肌缺血、梗死及室性心律失常的风险。我们研究了CABG术后及过夜机械通气后气管插管拔管时的血流动力学反应以及静脉注射利多卡因预处理的效果。25例患者分为两组：第1组（n = 13），用安慰剂预处理后行气管插管拔管的患者；第2组，气管插管拔管前接受利多卡因（1 mg/kg静脉注射）的患者。在气管插管拔管前、吸痰时以及气管插管拔管后1、5和20分钟获取血流动力学数据、心电图记录和动脉血气。第1组患者在吸痰时和气管插管拔管后1分钟内心率、动脉血压、心率 - 血压乘积、右心房压力和心脏指数显著升高，5分钟时恢复到拔管前水平。肺血管阻力指数和体循环阻力指数无显著变化。第2组患者的血流动力学变化与第1组相似。无论有无利多卡因，气管插管拔管引起的血流动力学反应幅度小且持续时间短。这些反应与心肌缺血或梗死的心电图或酶学证据无关，也与室性心律失常无关。与已充分记录的气管插管血流动力学反应相比，我们发现CABG术后气管插管拔管引起的反应不那么明显。这可能与避免喉镜检查以及可能对气管内导管的适应有关。CABG术后气管插管拔管时这些适度的血流动力学反应未因静脉注射利多卡因而改变。
