A Shono1, S Sakura, Y Saito, K Doi, T Nakatani. 1. Department of Anesthesiology, Shimane Medical University, 89-1 Enya-cho, Izumo City 693-8501, Japan.
Abstract
BACKGROUND: The authors compared the effects of epidural anaesthesia with lidocaine 1% and lidocaine 2% on haemodynamic variables, sevoflurane requirements, and stress hormone responses during surgery under combined epidural/general anaesthesia with bispectral index score (BIS) kept within the range 40-50. METHODS:Thirty-three patients undergoing lower abdominal surgery were randomly divided into two groups to receive lidocaine 1% or 2% by epidural with sevoflurane general anaesthesia. Sevoflurane was adjusted to achieve a target BIS of 40-50 during maintenance of anaesthesia with nitrous oxide 60% in oxygen. Measurements included the inspired (FI(SEVO)) and the end-tidal sevoflurane concentrations (E'(SEVO)), blood pressure (BP), and heart rate (HR) before surgery and every 5 min during surgery for 2 h. Plasma samples were taken immediately before and during surgery for measurements of catecholamines, cortisol, and lidocaine. RESULTS: During surgery, both groups were similar for HR, BP and BIS, but FI(SEVO) and E'(SEVO) were significantly higher and more variable with lidocaine 1% than with 2%. Intraoperative plasma concentrations of epinephrine and cortisol were found to be higher with lidocaine 1% as compared with 2%. CONCLUSIONS: To maintain BIS of 40-50 during combined epidural/general anaesthesia for lower abdominal surgery, sevoflurane concentrations were lower and less variable with lidocaine 2% than with 1%. In addition, the larger concentration of lidocaine suppressed the stress hormone responses better.
RCT Entities:
BACKGROUND: The authors compared the effects of epidural anaesthesia with lidocaine 1% and lidocaine 2% on haemodynamic variables, sevoflurane requirements, and stress hormone responses during surgery under combined epidural/general anaesthesia with bispectral index score (BIS) kept within the range 40-50. METHODS: Thirty-three patients undergoing lower abdominal surgery were randomly divided into two groups to receive lidocaine 1% or 2% by epidural with sevoflurane general anaesthesia. Sevoflurane was adjusted to achieve a target BIS of 40-50 during maintenance of anaesthesia with nitrous oxide 60% in oxygen. Measurements included the inspired (FI(SEVO)) and the end-tidal sevoflurane concentrations (E'(SEVO)), blood pressure (BP), and heart rate (HR) before surgery and every 5 min during surgery for 2 h. Plasma samples were taken immediately before and during surgery for measurements of catecholamines, cortisol, and lidocaine. RESULTS: During surgery, both groups were similar for HR, BP and BIS, but FI(SEVO) and E'(SEVO) were significantly higher and more variable with lidocaine 1% than with 2%. Intraoperative plasma concentrations of epinephrine and cortisol were found to be higher with lidocaine 1% as compared with 2%. CONCLUSIONS: To maintain BIS of 40-50 during combined epidural/general anaesthesia for lower abdominal surgery, sevoflurane concentrations were lower and less variable with lidocaine 2% than with 1%. In addition, the larger concentration of lidocaine suppressed the stress hormone responses better.
Authors: Patrick Tauzin-Fin; Olivier Bernard; Musa Sesay; Matthieu Biais; Philippe Richebe; Alice Quinart; Philippe Revel; Francois Sztark Journal: J Anaesthesiol Clin Pharmacol Date: 2014-07