静脉注射利多卡因输注仅在手术刺激期间减少基于双谱指数的异丙酚需求。

Intravenous lidocaine infusion reduces bispectral index-guided requirements of propofol only during surgical stimulation.

机构信息

Department of Anaesthesia and Intensive Care Medicine, CHU de Liège, University of Liège, Domaine du Sart-Tilman, B-4000 Liège, Belgium.

出版信息

Br J Anaesth. 2010 Oct;105(4):471-9. doi: 10.1093/bja/aeq189. Epub 2010 Jul 21.

DOI:10.1093/bja/aeq189

PMID:20650919

Abstract

BACKGROUND

I.V. lidocaine reduces volatile anaesthetics requirements during surgery. We hypothesized that lidocaine would also reduce propofol requirements during i.v. anaesthesia.

METHODS

A randomized controlled study of 40 patients tested the effect of i.v. lidocaine (1.5 mg kg(-1) then 2 mg kg(-1) h(-1)) on propofol requirements. Anaesthesia was maintained with remifentanil and propofol target-controlled infusions (TCI) to keep the bispectral index (BIS) around 50. Effect-site concentrations of propofol and remifentanil and BIS values were recorded before and after skin incision. Data were analysed using anova and mixed effects analysis with NONMEM. Two dose-response studies were then performed with and without surgical stimulation. Propofol TCI titrated to obtain a BIS around 50 was kept constant. Then patients were randomized into four groups: A, saline; B, 0.75 mg kg(-1) bolus then infusion 1 mg kg(-1) h(-1); C, 1.5 mg kg(-1) bolus and infusion 2 mg kg(-1) h(-1); and D, 3 mg kg(-1) bolus and infusion 4 mg kg(-1) h(-1). Lidocaine administration coincided with skin incision. BIS values and haemodynamic variables were recorded. Data were analysed using linear regression and two-way anova.

RESULTS

Lidocaine decreased propofol requirements (P<0.05) only during surgery. In the absence of surgical stimulation, lidocaine did not affect BIS nor haemodynamic variables, whereas it reduced BIS increase (P=0.036) and haemodynamic response (P=0.006) secondary to surgery.

CONCLUSIONS

The sparing effect of lidocaine on anaesthetic requirements seems to be mediated by an anti-nociceptive action.

摘要

背景

静脉注射利多卡因可减少手术期间挥发性麻醉剂的需求。我们假设利多卡因也会减少静脉麻醉期间异丙酚的需求。

方法

一项 40 例患者的随机对照研究测试了静脉注射利多卡因（1.5mg/kg 然后 2mg/kg/h）对异丙酚需求的影响。用瑞芬太尼和异丙酚靶控输注（TCI）维持麻醉，使脑电双频指数（BIS）保持在 50 左右。在切开皮肤前后记录异丙酚和瑞芬太尼的效应部位浓度和 BIS 值。使用方差分析和 NONMEM 混合效应分析进行数据分析。然后进行了两项有和没有手术刺激的剂量反应研究。保持异丙酚 TCI 滴定以获得 BIS 约 50 的浓度不变。然后将患者随机分为四组：A、生理盐水；B、0.75mg/kg 推注后输注 1mg/kg/h；C、1.5mg/kg 推注和输注 2mg/kg/h；D、3mg/kg 推注和输注 4mg/kg/h。利多卡因给药与皮肤切开同时进行。记录 BIS 值和血液动力学变量。使用线性回归和双向方差分析进行数据分析。