Rajan Sunil, Varghese Merin, Nair Anjali S, Kumar Lakshmi
Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
J Anaesthesiol Clin Pharmacol. 2024 Oct-Dec;40(4):666-671. doi: 10.4103/joacp.joacp_278_23. Epub 2024 Nov 15.
Nasotracheal intubation evokes greater hemodynamic responses than oral intubation. We compared the heart rate (HR) and mean arterial pressure (MAP) responses following nasal intubation during opioid-free anesthesia (OFA) using intravenous lignocaine versus standard regimen using morphine in cancer patients undergoing tumor resection.
This randomized, double-blinded study was conducted in 84 adults. Group A received lidocaine bolus 1.5 mg/kg over 10 min followed by infusion of 1 mg/kg/h. Group B received morphine 0.2mg/kg bolus over 10 min followed by infusion of 2mg/h. Protocols for induction and intubation were similar.
Mean HR and MAP at preinduction, immediately after induction, and at 1, 3, and 5 min after intubation were comparable in groups A and B. Intragroup comparison of preinduction HR with subsequent values in group A showed that the HR values at 1,3, and 5 min after intubation were significantly higher than the preinduction value. HR after induction was comparable. Intragroup analysis in group B showed that preinduction HR was comparable with HR after induction and at 3 and 5 min after intubation. HR at 1 min was significantly higher. Intragroup analysis in group A showed that the MAP values were significantly lower than the preinduction value after induction and at 1,3, and 5 min after intubation. In group B, MAP was significantly lower than the preinduction value after induction and at 3 and 5 min after intubation, with the value being comparable at 1 min.
OFA with lignocaine bolus followed by infusion, as well as morphine did not attenuate the HR responses to nasal intubation in cancer patients. However, both techniques effectively blunted the MAP response.
与经口插管相比，经鼻气管插管引起的血流动力学反应更强。我们比较了在无阿片类药物麻醉（OFA）期间，静脉注射利多卡因的经鼻插管与使用吗啡的标准方案在接受肿瘤切除的癌症患者中引起的心率（HR）和平均动脉压（MAP）反应。
这项随机、双盲研究纳入了84名成年人。A组在10分钟内静脉推注1.5mg/kg利多卡因，随后以1mg/kg/h的速度输注。B组在10分钟内静脉推注0.2mg/kg吗啡，随后以2mg/h的速度输注。诱导和插管方案相似。
A组和B组在诱导前、诱导后即刻以及插管后1、3和5分钟时的平均HR和MAP相当。A组诱导前HR与随后各时间点的组内比较显示，插管后1、3和5分钟时的HR值显著高于诱导前值。诱导后的HR相当。B组的组内分析显示，诱导前HR与诱导后以及插管后3和5分钟时的HR相当。1分钟时的HR显著更高。A组的组内分析显示，诱导后以及插管后1、3和5分钟时的MAP值显著低于诱导前值。在B组中，诱导后以及插管后第3和5分钟时的MAP显著低于诱导前值，1分钟时的值相当。
在癌症患者中，静脉推注利多卡因后输注以及吗啡的OFA方案均未减弱经鼻插管引起的HR反应。然而，两种技术均有效减弱了MAP反应。
