Abstract
Two groups of 12 patients were studied to determine the causes of hypertension during trans-sphenoidal resection of pituitary microadenomas. Two concentrations of lidocaine, 0.5 and 1.0 percent with epinephrine 1/200,000, were used to infiltrate the nose and upper gingiva. Heart rate, electrocardiogram lead II and systolic and diastolic arterial blood pressures were monitored. Three stages were observed for changes in above parameters: nasal infiltration, nasal dissection and sellar exploration. Highly significant reductions in arterial blood pressure and pulse rate responses to infiltration and nasal dissection were achieved by increasing the lidocaine concentration used for infiltration from 0.5 to 1.0 per cent (p < 0.05). Our findings implicate reflex from nasal stimulation as the main cause of the adverse cardiovascular effects. Only minimal changes accompanied the progress of the intrasellar dissection in both groups.
RéSUMé
La résection chirurgicale de microadénomes hypophysaires par une approche trans-sphénoidale provoque des poussées de tachycardie et d’hypertension inopportunes, occasionnées principalement par la stimulation de la muqueuse nasale et gingivale. Ces reactions réflexes ne sont pas maitrisées par l’infiltration d’une solution à 0.5 pour cent de lidocaine et épinephrine à 1/200,000. Par contre, 1’utilisation d’une solution à 1 pour cent de lidocaine et épinephrine à 1/200,000contrôle les effets cardiovasculaires durant I’infiltration, la dissection nasale et la résection intrasellaire.
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References
Allison, D.J. Correspondence. Reflexes from the nose. N. Engl. J. Med.299: 1468(1978).
Messick, J.M., Jr.,Laws, E.R., Jr &Abboud, C.F. Anesthesia for trans-sphenoidal surgery of the hypophyseal region. Anesth. & Analg.57: 206 (1978).
Daniel, R.K. Microsurgery: through the looking glass. N. Engl. J. Med.300: 1251(1979).
Horrigan, R. W., ECer, E.I. &Wilson, C. Epinephrine-induced arrhythmias during enflurane anesthesia in man: a nonlinear dose-response relationship and dose-dependent protection from lidocaine. Anesth. & Analg.57: 547(1978).
Oparil, S. &Haber, E. The renin-angiotensin system (first of two parts). N. Engl. J. Med.291: 389(1974).
Frantz, A.G. Prolactin. N. Engl. J. Med.298: 201 (1978).
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Abou-Madi, M.N., Trop, D. & Barnes, J. Aetiology and control of cardiovascular reactions during trans-sphenoidal resection of pituitary microadenomas. Canad. Anaesth. Soc. J. 27, 491–495 (1980). https://doi.org/10.1007/BF03007050
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DOI: https://doi.org/10.1007/BF03007050