Olatosi J O, Ehiozie-Osifo A
Department of Anaesthesia, Lagos University Teaching Hospital, Lagos, Nigeria.
J West Afr Coll Surg. 2016 Jan-Mar;6(1):47-69.
Laryngoscopy and tracheal intubation are an integral component of airway management and general anaesthesia. Direct stimulation of the pharynx and larynx by the laryngoscope blade and the insertion of an endotracheal tube elicit a sympathetic nervous system response with a reflex consisting of a transient increase in blood pressure, heart rate, and the occurrence of cardiac dysrhythmias referred to as the 'pressor' response. This may be of major clinical significance in patients with pre-existing systemic hypertension, hypertensive heart disease, coronary artery disease, eclampsia, aneurysmal vascular disease and head injury in whom such a change may culminate in perioperative myocardial ischaemia or infarction, cardiac failure, dysrhythmias, cerebrovascular accidents or secondary brain injury.
To evaluate and compare the effects of intravenous lidocaine and esmolol on the pressor response as well as determine the occurrence of complications with the use of either agent in a Nigerian population.
Ninety adult ASA I and II patients undergoing elective non-cardiac surgery under general anaesthesia were randomly allocated to one of 3 groups; group E: 2mg.kg esmolol, group L: 1.5mg.kg lidocaine and group C: 20mls normal saline 3 minutes before laryngoscopy. Induction of anaesthesia was standardized for all patients. Heart Rate, Systolic Blood Pressure, Diastolic Blood Pressure, Mean Arterial Pressure and Rate Pressure Product were recorded at baseline, immediate post, 1, 3, 5 and 10 minutes after intubation.
Mean heart rate increased by 19.1%, 25.7%, and 41.4%, SBP increased 13.3%, 21.6% and 26.9%, MAP by 12.2%, 19.1% and 30.2%, RPP by 28.1%, 45.8% and 78.7% in groups E, L and C respectively post intubation. There were no complications attributable to the use of either agent.
Intravenous esmolol 2mg.kg given prior to laryngoscopy is more effective than intravenous lidocaine 1.5mg.kg in significantly attenuating the haemodynamic changes associated with pressure response to laryngoscopy and endotracheal intubation in normotensive patients from a Nigerian population.
喉镜检查和气管插管是气道管理和全身麻醉的重要组成部分。喉镜镜片直接刺激咽和喉以及气管导管的插入会引发交感神经系统反应，其反射包括血压短暂升高、心率加快以及出现称为“升压”反应的心律失常。这对于患有系统性高血压、高血压性心脏病、冠状动脉疾病、子痫、动脉瘤性血管疾病和头部损伤的患者可能具有重大临床意义，在这些患者中，这种变化可能最终导致围手术期心肌缺血或梗死、心力衰竭、心律失常、脑血管意外或继发性脑损伤。
评估和比较静脉注射利多卡因和艾司洛尔对升压反应的影响，并确定在尼日利亚人群中使用这两种药物时并发症的发生情况。
90例接受全身麻醉下择期非心脏手术的成年ASA I级和II级患者被随机分配到3组之一；E组：2mg·kg艾司洛尔，L组：1.5mg·kg利多卡因，C组：喉镜检查前3分钟静脉注射20ml生理盐水。所有患者的麻醉诱导均标准化。在基线、插管后即刻、插管后1、3、5和10分钟记录心率、收缩压、舒张压、平均动脉压和心率血压乘积。
插管后，E组、L组和C组的平均心率分别增加了19.1%、25.7%和41.4%，收缩压分别增加了13.3%、21.6%和26.9%，平均动脉压分别增加了12.2%、19.1%和30.2%，心率血压乘积分别增加了28.1%、45.8%和78.7%。使用这两种药物均未出现并发症。
在尼日利亚血压正常的人群中，喉镜检查前静脉注射2mg·kg艾司洛尔在显著减轻与喉镜检查和气管插管压力反应相关的血流动力学变化方面比静脉注射1.5mg·kg利多卡因更有效。
