Department of Anesthesiology, Second Affiliated Hospital, Anesthesiology Key Laboratory, Harbin Medical University, Harbin, China; Education Department of Heilongjiang Province, China.
J Cardiothorac Vasc Anesth. 2013 Dec;27(6):1295-300. doi: 10.1053/j.jvca.2012.12.020. Epub 2013 May 22.
To compare the effects of thoracic epidural anesthesia (TEA) and intravenous (IV) lidocaine on the effect-site concentration (Ce) of propofol target-controlled infusion (TCI) and the intubation-induced stress responses during general IV anesthesia induction.
A prospective, randomized trial.
A university hospital.
Sixty patients undergoing elective surgery for thoracotomies.
Patients scheduled for thoracotomies were divided into 3 groups as group TEA, group IV, and control group. Group TEA or group IV received the same doses but not the same concentration of lidocaine via TEA (0.15 mL/kg of 1.35% lidocaine) or IV (2mg/kg of 2% lidocaine), respectively, 15 minutes before induction of anesthesia, and the control group received the same volume of 0.9% normal saline epidurally.
Heart rate and mean arterial pressure as well as the time to loss of consciousness (LOC), total doses of propofol TCI, and Ce at LOC were recorded during anesthesia induction. Plasma lidocaine concentration detected was 1.9 (0.3) μg/mL in the IV group and 1.0 (0.3) μg/mL in the TEA group (p<0.001). The time to LOC, total doses of propofol TCI, and Ce at LOC were significantly lower in the IV group than in the TEA group and the control group (p<0.001). Both lidocaine groups showed significant decreases in the elevation of mean arterial pressure and heart rate and plasma concentrations of epinephrine and norepinephrine induced by intubation compared to the control group (p< 0.05).
Lidocaine administered via both TEA and IV decreased the induction doses of propofol and suppressed cardiovascular and stress responses to tracheal intubation. Administration of 2mg/kg of 2% lidocaine IV was better, with no side effects of lidocaine toxicity.
比较胸段硬膜外麻醉（TEA）和静脉（IV）利多卡因对异丙酚靶控输注（TCI）效应部位浓度（Ce）的影响，以及全身 IV 麻醉诱导期间插管引起的应激反应。
前瞻性、随机试验。
一所大学医院。
60 例行胸腔切开术的择期手术患者。
拟行胸腔切开术的患者分为 3 组：TEA 组、IV 组和对照组。TEA 组或 IV 组在麻醉诱导前 15 分钟分别给予相同剂量但不同浓度的利多卡因（TEA 组 0.15mL/kg 1.35%利多卡因，IV 组 2mg/kg 2%利多卡因），对照组给予相同容量的 0.9%生理盐水硬膜外。
记录麻醉诱导期间的心率和平均动脉压，意识丧失（LOC）时间，异丙酚 TCI 的总剂量，以及 LOC 时的 Ce。IV 组检测到的血浆利多卡因浓度为 1.9（0.3）μg/mL，TEA 组为 1.0（0.3）μg/mL（p<0.001）。IV 组的 LOC 时间、异丙酚 TCI 的总剂量和 LOC 时的 Ce 明显低于 TEA 组和对照组（p<0.001）。与对照组相比，利多卡因组在插管引起的平均动脉压和心率升高以及肾上腺素和去甲肾上腺素的血浆浓度方面均显著降低（p<0.05）。
通过 TEA 和 IV 给予利多卡因可降低异丙酚的诱导剂量，并抑制心血管和应激反应气管插管。静脉给予 2mg/kg 2%利多卡因效果更好，且无利多卡因毒性的副作用。
