论著
Cui Weihua;Tan Hong;Han Ruquan;Li Yanping;Li Shuren
2011, 13(1): 1-6.
Objective: To study the effect of lowdose lidocaine on the efficiency of induction and maintenance of propofol anesthesia. Methods: Forty ASA physical status ⅠorⅡpatients aged 18-65 years, who were scheduled to undergo elective thoracotomy under general anesthesia with propofol, were enrolled in the study and randomly divided into the following two groups by using ballot method: the lidocaine group and the control group (20 patients in each group). The administration sequence during the anesthetic induction and maintenance in the two groups were as follows: (1) the patients received an IV infusion of midazolam maleate 0.03 mg/kg; (2) the patients in the lidocaine group were initially administered an IV infusion of lidocaine 1 mg/kg, followed by a continuous IV infusion of lidocaine 33 μg·kg-1·min-1, and the patients in the control group were administered the same volume of 0.9% sodium chloride at the same rate; (3) the patients received an IV infusion of remifentanil 1 μg/kg, followed by a continuous IV infusion of remifentanil 0.2 μg·kg-1·min-1; (4) an IV infusion of propofol was given, the initial target propofol blood concentration for induction was 1 ml/L, and then increased in steps of 0.3 mg/L at a time, achieving a stable bispectral index (BIS) of 4060; (5) rocuronium was given intravenously 0.6 mg/kg after the patients lost consciousness. The differences in BIS, heart rate, invasive arterial pressure(IAP), target propofol blood concentration, effect compartment propofol concentration, pharyngonasal temperature, doses of atropine or ephedrine or nitroglycerin, adverse reactions and complications in the two groups at the different time points during intraoperative period were monitored and compared. The patients’lidocaine blood concentrations were monitored. Results: The lidocaine group comprised 13 males and 7 females with average age of (54±9）years. The control group comprised 13 males and 7 females with average age of (51±1）years. There were no statistically significant differences in baseline patient characteristics, doses of atropine or ephedrine or nitroglycerin, BIS, IAP, pharyngonasal temperature, and the incidence of adverse reaction between the two groups. There were no serious adverse reactions and complications in the two groups. The target propofol blood concentration and effect compartment propofol blood concentration in the lidocaine and control groups at the different time points were respectively compared as follows: at the time of tracheal intubation, the concentrations were(1.9±0.4) mg/L vs(2.4±0.4) mg/L and (1.2±0.4) mg/L vs (1.6±0.4) mg/L，respectively；at the time of organ resection, the concentrations were (2.0±0.5) mg/L vs (2.7±0.7) mg/L and (2.0±0.5) mg/L vs (2.7±0.7) mg/L, respectively；at the time of chest cavity shut, the concentrations were(1.7±0.4) mg/L vs(2.2±0.7) mg/L and (1.8±0.4) mg/L vs (2.3±0.7) mg/L, respectively； at the time of tracheal extubation, the concentrations were(0.8±0.2) mg/L vs(0.9±0.2) mg/L and (0.9±0.2) mg/L vs(1.0±0.3) mg/L, respectively. The differences were statistically significant (all P＜0.05). The patients’ lidocaine blood concentration 30, 120, 240 minutes after anesthetic induction and after surgery completion were(2.24±0.53), (2.20±0.42), (2.45±0.73) and (2.31±0.75) mg/L, respectively, and they were lower than a toxic blood concentration of lidocaine (8.0 mg/L). Conclusion: The low-dose lidocaine can increase the efficiency of induction and maintenance of propofol anesthesia.
