静脉注射利多卡因降低肥胖患者气管插管时舒芬太尼的半数有效浓度。

Intravenous Lidocaine Decreased the Median Effective Concentration of Sufentanil for Tracheal Intubation in Obese Patients.

机构信息

Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China.

出版信息

Drug Des Devel Ther. 2023 Aug 21;17:2431-2439. doi: 10.2147/DDDT.S415872. eCollection 2023.

DOI:10.2147/DDDT.S415872

PMID:37637263

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10457462/

Abstract

PURPOSE

Sufentanil has been widely used to inhibit the hemodynamic responses caused by tracheal intubation. Using intravenous lidocaine may reduce the dose of sufentanil and better maintain the hemodynamics. This study aimed to determine the effects of intravenous lidocaine on the median effective concentration (EC50) of sufentanil for endotracheal intubation in obese patients.

PATIENTS AND METHODS

This is a randomized, double-blind, up-and-down sequential allocation study. Fifty obese patients undergoing bariatric surgery were randomly allocated in a 1:1 ratio into the lidocaine group and the saline group. Anesthesia was induced using a target-controlled infusion of propofol and sufentanil. The effect-site concentration (Ce) of propofol was 3.5 μg/mL. The Ce of sufentanil for the first patient was 0.4 ng/mL, and the sufentanil dose for the next patient was determined according to the responses of the previous patient, using Dixon's up-and-down sequential method with an interval of 0.05 ng/mL. When the target concentration of propofol and sufentanil was reached, lidocaine 1.5 mg/kg or the same volume of normal saline was infused over 3 min. Tracheal intubation was performed 3 min after the end of the lidocaine or normal saline infusion. Probit regression was used to calculate the EC50 and 95% confidence interval (CI) of sufentanil.

RESULTS

Thirty-eight patients completed this study. The EC50 of sufentanil was 0.36 ng/mL (95% CI: 0.31-0.41 ng/mL) in the lidocaine group, which was significantly lower than 0.50 ng/mL (95% CI: 0.43-0.62 ng/mL) in the saline group. In addition, compared with saline group, the dosage of sufentanil in lidocaine group decreased significantly during the test. The hemodynamics of the two groups were stable during the study period.

CONCLUSION

Intravenous lidocaine 1.5 mg/kg decreased the EC50 of sufentanil required for tracheal intubation in obese patients undergoing bariatric surgery.

摘要

目的

舒芬太尼被广泛用于抑制气管插管引起的血流动力学反应。静脉注射利多卡因可以减少舒芬太尼的剂量，并更好地维持血流动力学。本研究旨在确定静脉注射利多卡因对肥胖患者气管插管时舒芬太尼的半数有效浓度（EC50）的影响。

患者和方法

这是一项随机、双盲、上下序贯分配研究。50 名接受减肥手术的肥胖患者以 1:1 的比例随机分配到利多卡因组和生理盐水组。采用丙泊酚和舒芬太尼靶控输注诱导麻醉。丙泊酚效应部位浓度（Ce）为 3.5 μg/mL。第一个患者的舒芬太尼 Ce 为 0.4 ng/mL，下一个患者的舒芬太尼剂量根据前一个患者的反应确定，采用 Dixon 上下序贯法，间隔 0.05 ng/mL。当达到丙泊酚和舒芬太尼的目标浓度后，在 3 分钟内输注利多卡因 1.5 mg/kg 或相同体积的生理盐水。在利多卡因或生理盐水输注结束后 3 分钟进行气管插管。采用概率回归法计算舒芬太尼的 EC50 和 95%置信区间（CI）。

结果

38 名患者完成了这项研究。利多卡因组舒芬太尼的 EC50 为 0.36 ng/mL（95%CI：0.31-0.41 ng/mL），明显低于生理盐水组的 0.50 ng/mL（95%CI：0.43-0.62 ng/mL）。此外，与生理盐水组相比，利多卡因组在测试过程中舒芬太尼的剂量明显减少。两组患者在研究期间的血流动力学均稳定。