Xue Fu S, Liu He P, He Nong, Xu Ya C, Yang Quan Y, Liao Xu, Xu Xiu Z, Guo Xin L, Zhang Yan M
Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-Da-Chu Rd, Shi-Jing-Shan District, Beijing, People's Republic of China 100144.
Anesth Analg. 2009 Feb;108(2):536-43. doi: 10.1213/ane.0b013e31818f1665.
We designed this randomized, double-blind clinical study to compare the safety and efficacy of 2% and 4% lidocaine during airway topical anesthesia with a spray-as-you-go technique via the fiberoptic bronchoscope.
Fifty-two adult patients with a difficult airway were randomly assigned to 1 of 2 study groups to receive 2% (Group 1) or 4% lidocaine (Group 2) by a spray-as-you-go technique with the fiberoptic bronchoscope, in a double-blind manner. After airway topical anesthesia, awake fiberoptic orotracheal intubation (FOI) was performed. Level of sedation, time for each lidocaine spray in different targeted areas, total times for airway sprays, total dosages of lidocaine used for airway sprays, intubation times, and number of intubation attempts were noted. An independent investigator scored patients' comfort during airway topical anesthesia, patients' reaction, coughing severity, and intubating condition during awake FOI, and observed changes of arterial blood pressure and heart rate during each stage in the airway manipulation process. Serial blood samples were obtained for analysis of plasma lidocaine concentrations.
Except for the total dosages and plasma concentrations of lidocaine, there were no significant differences in any of the observed variables between groups. All patients exhibited excellent or acceptable intubating conditions. The total dosages of lidocaine were significantly smaller in Group 1 (3.4 +/- 0.6 mg/kg) than in Group 2 (7.1 +/- 2.1 mg/kg). The plasma lidocaine concentrations in all observed points after the supraglottic sprays were larger in Group 2 than in Group 1.
Both 2% and 4% lidocaine administered topically by a spray-as-you-go technique can provide clinically acceptable intubating conditions for awake FOI in sedated patients with a difficult airway. As compared with 4% lidocaine, however, 2% lidocaine requires a smaller dosage and results in lower plasma concentrations.
我们设计了这项随机、双盲临床研究，以比较在纤维支气管镜引导下采用边喷药边操作技术进行气道表面麻醉时，2%利多卡因和4%利多卡因的安全性和有效性。
52例气道困难的成年患者被随机分为2个研究组中的1组，以双盲方式通过纤维支气管镜采用边喷药边操作技术接受2%（第1组）或4%利多卡因（第2组）。气道表面麻醉后，进行清醒纤维光导经口气管插管（FOI）。记录镇静水平、不同目标区域每次利多卡因喷雾的时间、气道喷雾的总时间、气道喷雾所用利多卡因的总剂量、插管时间和插管尝试次数。一名独立研究者对患者气道表面麻醉期间的舒适度、患者反应、咳嗽严重程度以及清醒FOI期间的插管情况进行评分，并观察气道操作过程中各阶段动脉血压和心率的变化。采集系列血样以分析血浆利多卡因浓度。
除利多卡因的总剂量和血浆浓度外，两组间在任何观察变量上均无显著差异。所有患者均表现出良好或可接受的插管条件。第1组利多卡因的总剂量（3.4±０.6mg/kg）显著低于第2组（7.1±2.1mg/kg）。声门上喷雾后所有观察点的第2组血浆利多卡因浓度均高于第1组。
对于气道困难的镇静患者，采用边喷药边操作技术局部给予2%和4%利多卡因均可为清醒FOI提供临床上可接受的插管条件。然而，与4%利多卡因相比，2%利多卡因所需剂量更小，血浆浓度更低。
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