Department of Anesthesia, MUHC-Royal Victoria Hospital, Montreal, QC, Canada.
Anaesthesia. 2010 Jan;65(1):12-7. doi: 10.1111/j.1365-2044.2009.06126.x. Epub 2009 Nov 6.
Airway anaesthesia using atomised lidocaine for awake oral fibreoptic intubation in morbidly obese patients was evaluated using two doses of local anaesthetic. In this randomised, blinded prospective study, 40 ml of atomised 1% (n = 11) or 2% (n = 10) lidocaine was administered with high oxygen flow as carrier. Outcomes included time for intubation, patient tolerance to airway manipulation, haemodynamic parameters, the bronchoscopist's overall satisfaction, and serial serum lidocaine concentrations. Patients receiving lidocaine 1% had a longer mean (SD) time from the start of topicalisation to tracheal tube cuff inflation than those receiving lidocaine 2% (8.6 (0.9) min vs 6.9 (0.5) min, respectively; p < 0.05). Patients in the 1% cohort demonstrated increased responses to airway manipulation (p < 0.0001), reflecting lower bronchoscopist's satisfaction scores (p < 0.03). Haemodynamic responses to topicalisation and airway manipulation were similar in both groups. Peak plasma concentration was lower in the 1% group (mean (SD) 1.4 (0.3) and 3.8 (0.5) microg.ml(-1), respectively; p < 0.001). Airway anaesthesia using atomised lidocaine for awake oral fibreoptic intubation in the morbidly obese is efficacious, rapid and safe. Compared with lidocaine 1%, the 2% dose provides superior intubating conditions.
在肥胖患者清醒状态下经口纤维支气管镜插管中，使用雾化利多卡因进行气道麻醉，并采用两种局麻药剂量进行评估。在这项随机、双盲前瞻性研究中，用高流量氧气作为载体给予 40ml 雾化 1%（n=11）或 2%（n=10）利多卡因。结局包括插管时间、患者对气道操作的耐受性、血流动力学参数、支气管镜医师的总体满意度以及血清利多卡因浓度的连续变化。接受 1%利多卡因的患者从局部麻醉开始到气管导管套囊充气的平均（SD）时间长于接受 2%利多卡因的患者（分别为 8.6（0.9）分钟和 6.9（0.5）分钟；p<0.05）。1%组的患者对气道操作的反应增加（p<0.0001），反映出支气管镜医师的满意度评分较低（p<0.03）。两组患者的局部麻醉和气道操作的血流动力学反应相似。1%组的峰值血浆浓度较低（分别为 1.4（0.3）和 3.8（0.5）μg.ml(-1)；p<0.001）。在肥胖患者清醒状态下经口纤维支气管镜插管中，使用雾化利多卡因进行气道麻醉是有效、快速和安全的。与 1%利多卡因相比，2%剂量提供了更好的插管条件。
