Mizuyama K, Sato S, Watanabe S, Naito H
Department of Anesthesia, Tsuchiura Kyodo Hospital.
Masui. 1991 Aug;40(8):1183-6.
Arterial blood concentrations of lidocaine were measured in 7 patients undergoing pancreas operation during continuous epidural anesthesia and repeated doses of lidocaine were given according to the skin temperature of the toe. After the epidural catheter placement at the middle level of thoracic spine, 3 ml (test dose) plus 9 ml of 2% lidocaine with epinephrine (1:200,000) were injected. Additional doses of lidocaine, 6 ml, were injected when the skin temperature of the toe decreased for 0.3 degrees C. Two cases were excluded from this study because the skin temperature did not increase following additional doses of lidocaine. Lidocaine was added for 3.4 times on an average during anesthesia (duration 345 +/- 35 min, mean +/- SE). The first, second, third and fourth intervals of repeated injections from the initiation of epidural anesthesia were 119 +/- 10 min, 184 +/- 16 min, 251 +/- 20 min and 323 +/- 27 min, respectively. Arterial blood concentrations of lidocaine before each injection were 2.4 to 2.8 micrograms.ml-1 and these values showed no significant changes. These results demonstrate that the estimation of the necessity of additional injections by monitoring the skin temperature during prolonged epidural anesthesia prevents the lidocaine intoxication.
在7例接受胰腺手术的患者持续硬膜外麻醉期间测定利多卡因的动脉血浓度，并根据脚趾皮肤温度给予重复剂量的利多卡因。在胸段脊柱中部放置硬膜外导管后，注入3 ml（试验剂量）加9 ml含肾上腺素（1:200,000）的2%利多卡因。当脚趾皮肤温度下降0.3℃时，注入6 ml额外剂量的利多卡因。本研究排除2例患者，因为额外注射利多卡因后皮肤温度未升高。麻醉期间平均追加利多卡因3.4次（持续时间345±35分钟，平均值±标准误）。从硬膜外麻醉开始，重复注射的第一、第二、第三和第四间隔分别为119±10分钟、184±16分钟、251±20分钟和323±27分钟。每次注射前利多卡因的动脉血浓度为2.4至2.8微克·毫升-1，这些值无显著变化。这些结果表明，在长时间硬膜外麻醉期间通过监测皮肤温度来估计追加注射的必要性可防止利多卡因中毒。
