Department of Anaesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
Department of Anaesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
Anaesth Crit Care Pain Med. 2021 Feb;40(1):100731. doi: 10.1016/j.accpm.2020.06.017. Epub 2020 Sep 5.
Patients with septic shock commonly require endotracheal intubation under general anaesthesia in the operating theatre, the emergency department, and the intensive care unit. Hypotension is a serious complication after induction of general anaesthesia, especially in patients with circulatory failure. No randomised controlled trials had previously investigated protocols for induction of anaesthesia in septic shock patients. The aim of the current work is to compare two protocols, lidocaine-ketamine combination versus ketamine full-dose for rapid-sequence endotracheal intubation in patients with septic shock.
Forty-four adult patients, with septic shock, scheduled for emergency surgical intervention were enrolled in this randomised, double-blinded, controlled study. Patients were randomised to receive either 1 mg/kg ketamine (ketamine group, n = 22) or 0.5 mg/kg ketamine plus 1 mg/kg lidocaine (ketamine-lidocaine group, n = 22) for induction of anaesthesia in addition to 0.05 mg/kg midazolam (in both groups). Our primary outcome was the mean arterial pressure (MAP). Other outcomes included frequency of post-induction hypotension, heart rate, and cardiac output.
Forty-three patients were available for final analysis. The average MAP reading in the first 5 min post-induction was higher in ketamine-lidocaine group than in the ketamine group {82.8 ± 5.6 mmHg and 73 ± 10.2 mmHg, P < 0.001}. Furthermore, the incidence of post-intubation hypotension was lower in the ketamine-lidocaine group than in the ketamine group {1 patient (5%) versus 17 patients (77%), P < 0.001}. The ketamine-lidocaine group showed higher MAP in almost all the readings after induction compared to ketamine group. Other haemodynamic variables including cardiac output and heart rate were comparable between both study groups.
Lidocaine-ketamine combination showed less incidence of hypotension compared to ketamine full-dose when used for rapid-sequence endotracheal intubation in patients with septic shock. REGISTRATION URL: https://clinicaltrials.gov/ct2/show/NCT03844984?cond=NCT03844984&rank=1.
脓毒性休克患者通常需要在手术室、急诊室和重症监护病房进行全身麻醉下的气管插管。低血压是全身麻醉诱导后的严重并发症，特别是在循环衰竭患者中。以前没有随机对照试验研究过脓毒性休克患者麻醉诱导的方案。本研究旨在比较利多卡因-氯胺酮联合方案与氯胺酮全剂量方案在脓毒性休克患者快速序贯气管插管中的作用。
本研究为一项随机、双盲、对照研究，纳入了 44 名拟行紧急手术的成年脓毒性休克患者。患者随机接受 1mg/kg 氯胺酮（氯胺酮组，n=22）或 0.5mg/kg 氯胺酮加 1mg/kg 利多卡因（氯胺酮-利多卡因组，n=22）联合 0.05mg/kg 咪达唑仑（两组）用于麻醉诱导。主要结局为平均动脉压（MAP）。其他结局包括诱导后低血压的发生率、心率和心输出量。
43 名患者最终纳入分析。氯胺酮-利多卡因组诱导后 5 分钟内的平均 MAP 读数高于氯胺酮组{82.8±5.6mmHg 和 73±10.2mmHg，P<0.001}。此外，氯胺酮-利多卡因组的气管插管后低血压发生率低于氯胺酮组{1 例（5%）比 17 例（77%），P<0.001}。与氯胺酮组相比，氯胺酮-利多卡因组在诱导后几乎所有的 MAP 读数中均显示出更高的 MAP。两组的其他血流动力学变量，包括心输出量和心率，均相似。
与氯胺酮全剂量相比，在脓毒性休克患者中进行快速序贯气管插管时，利多卡因-氯胺酮联合使用的低血压发生率较低。
https://clinicaltrials.gov/ct2/show/NCT03844984?cond=NCT03844984&rank=1.
