Abstract
This study was designed to evaluate the effect of tracheal topical anesthesia using EMLA® Cream (EC) coated on the endotracheal tube (ETT) with or without epidural anesthesia (EA) on isoflurane requirement during general anesthesia (GA) and investigate whether EC coated on the ETT with EA was associated with the additive effect compared with the effect when each anesthetic was administered independently. The prospective randomized, double-blinded, and controlled study included 60 ASA I–II patients scheduled for upper abdominal surgery requiring GA. Patients were randomly assigned to one of the following groups: group 1 received GA, group 2 received EC + GA, group 3 received GA + EA, and group 4 received EC + GA + EA. Isoflurane was administered at the required concentrations to maintain the mean arterial pressure at a level not exceeding 20% of preoperative values. The percentage mean expired concentration (%MEC) was used in calculating the isoflurane requirement. Emergence agitation, postoperative sore throat, and hoarseness were recorded. Groups 2, 3, and 4 exhibited a significant reduction on isoflurane requirement compared with group 1 (P < 0.05). The isoflurane requirement evaluated by %MEC decreased by 12%, 38%, and 50% in groups 2, 3, and 4, respectively. The incidence of emergence agitation was significantly lower in groups 2 and 4 than those in groups 1 and 3 (P < 0.05). Tracheal topical anesthesia using EC coated on ETT with or without EA reduced the isoflurane requirement during GA, indicating that EC combined with EA exhibited an additive effect on the requirement of general anesthetic.
Similar content being viewed by others
References
Tverskoy M, Shifrin V, Finger J, Fleyshman G, Kissin I. Effect of epidural bupivacaine block on midazolam hypnotic requirements. Reg Anesth 1996; 21(3): 209–213
Hossain M, Hoq MF, Rahman MS, Yeasmeen S, Ahmed A, Huda MR, Rahman MM. Vecuronium and fentanyl requirement in abdominal surgery under combined epidural-general anaesthesia and general anaesthesia alone. Mymensingh Med J 2012; 21(1): 55–59
Li Y, Zhu S, Yan M. Combined general/epidural anesthesia (ropivacaine 0.375%) versus general anesthesia for upper abdominal surgery. Anesth Analg 2008; 106(5): 1562–1565
Hodgson PS, Liu SS. Epidural lidocaine decreases sevoflurane requirement for adequate depth of anesthesia as measured by the Bispectral Index monitor. Anesthesiology 2001; 94(5): 799–803
Casati L, Fernández-Galinski S, Barrera E, Pol O, Puig MM. Isoflurane requirements during combined general/epidural anesthesia for major abdominal surgery. Anesth Analg 2002; 94(5): 1331–1337
Lu CH, Borel CO, Wu CT, Yeh CC, Jao SW, Chao PC, Wong CS. Combined general-epidural anesthesia decreases the desflurane requirement for equivalent A-line ARX index in colorectal surgery. Acta Anaesthesiol Scand 2005; 49(8): 1063–1067
Reinoso-Barbero F, Martínez-García E, Hernández-Gancedo MC, Simon AM. The effect of epidural bupivacaine on maintenance requirements of sevoflurane evaluated by bispectral index in children. Eur J Anaesthesiol 2006; 23(6): 460–464
Zhang J, Zhang W, Li B. The effect of epidural anesthesia with different concentrations of ropivacaine on sevoflurane requirements. Anesth Analg 2007; 104(4): 984–986
Kim SH, Chun DH, Chang CH, Kim TW, Kim YM, Shin YS. Effect of caudal block on sevoflurane requirement for lower limb surgery in children with cerebral palsy. Paediatr Anaesth 2011; 21(4): 394–398
Yu H, Yang XY, Liu B. EMLA Cream coated on the rigid bronchoscope for tracheobronchial foreign body removal in children. Laryngoscope 2009; 119(1): 158–161
Samsó E, Vallés J, Pol O, Gallart L, Puig MM. Comparative assessment of the anaesthetic and analgesic effects of intramuscular and epidural clonidine in humans. Can J Anaesth 1996; 43(12): 1195–1202
Dwyer R, Bennett HL, Eger EI 2nd, Peterson N. Isoflurane anesthesia prevents unconscious learning. Anesth Analg 1992; 75(1): 107–112
Gonsowski CT, Chortkoff BS, Eger EI 2nd, Bennett HL, Weiskopf RB. Subanesthetic concentrations of desflurane and isoflurane suppress explicit and implicit learning. Anesth Analg 1995; 80(3): 568–572
Liu J, Klein KW, Griffin JD, White PF. Does monitoring end-tidal isoflurane concentration improve titration during general anesthesia? J Clin Anesth 1995; 7(3): 186–191
Maves TJ, Gebhart GF. Analgesic synergy between intrathecal opioids and local anesthetics. Anesth Analg 1991; 73(3): 365–366
Soltani HA, Aghadavoudi O. The effect of different lidocaine application methods on postoperative cough and sore throat. J Clin Anesth 2002; 14(1): 15–18
Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, Domino KB. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg 2004; 99(3): 833–839
Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, Saager L, Turner MS, Rao S, Bottros M, Hantler C, Jacobsohn E, Evers AS. Anesthesia awareness and the bispectral index. N Engl J Med 2008; 358(11): 1097–1108
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yu, H., Chu, Q., Liu, J. et al. EMLA® cream coated on endotracheal tube with or without epidural lidocaine reduces isoflurane requirement during general anesthesia. Front. Med. 6, 302–306 (2012). https://doi.org/10.1007/s11684-012-0194-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11684-012-0194-6