Abstract
The authors determined the cardiovascular effects of blind nasotracheal intubation in four randomized groups of 25 patients each, After induction of anaesthesia with IV thiopentone 4 mg-kg-1, patients in group A received no pretreatment, while patients in group B received IV iidocaine 1.5 mg-kg-1. Three minutes before induction, patients in group C received 0 25 per cent phenylephrine nasal spray (0.2 mg in each nostril); those in group D received ten per cent Iidocaine nasal spray (30 mg in each nostril). After intubation, mean arterial pressures (MAP) were highest in group B (IV Iidocaine) patients (p < 0.05), remaining significantly elevated for 5 min. Conversely, within four minutes after intubation, MAP of group D (ten per cent nasal Iidocaine spray) patients were below control (p < 0.05), and lower than those of any other group (p < 0.05). MAP of group A and C patients increased after intubation, but not as much as in group B patients (p < 0.05). There were no adverse effects from the lidocaine nasal spray. Ten per cent lidocaine nasal spray is a safe and effective way to minimize the MAP increases which typically accompany blind nasotracheal intubation in lightly anaesthetized patients.
Résumé
Ce travail a porté sur I’observation des ejfets cardiovas-culairesde I’intubation naso-trachéle à I’aveugle chez 100 maiades distribués au hasard également dans quatre groupes différents. Après I’induction de I’anesthésie au thiopental intrave’meux (4 mg-kg-1), ies patients du groupe A ne recurent aucune médication, ceux du groupe requrent de la lidoca’i’ne intraveineuse a 1.5 mg-kg-’. Trois minutes avant ’induction Ies patients du groupe C requrent de la phenylephrine 0.25 pour cent en vaporisation nasale (0.2 mg dans chaque narine). Les maiades du groupe D requrent de la lidoca’i’ne dix pour vent en vaporisation nasale (30 mg dans chaque narine), Apres !’intubation les pressions arterielles moyennes (MAP) etaieni plus elevees chez les patients du groupe B (lidoca’i’ne IV) (p < 0,05). Les pressions se sont maintenues elevees pendant cinq minutes.
Inversement, mains de quatre minutes apres i intubation, les pressions arterielles des patients du groupe D (lidocai’ne dix pour cent par voie nasale) etaient en bas des valeurs de controle (p < 0.05) et plus basses que les pressions trouvees dans les autres groupes (p < 0.05). Les pressions arterielles moyennes des patients des groupes A et C ont augmente apres V intubation rnais mains que chez les patients du groupe B (p < 0,05). On n’a observe aucun effet indesirable de la vaporisation nasale de licocame. La lidocai’ne a dix pour cent en vaporisation nasale represente done un moyen sur et efficace de diminuer la riponse hypertensive qui accompagne régulièrement I ’intubation naso-trachéale chez les patients sous anesthésie légère.
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Presented in part at the annual meeting of the American Society of Anesthesiologists, Atlanta, Georgia, October, 1983.
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Hartigan, M.L., Cleary, J.L., Gross, J.B. et al. A comparison of pre treatment regimens for minimizing the haemodynamic response to blind nasotracheal intubation. Can Anaesth Soc J 31, 497–502 (1984). https://doi.org/10.1007/BF03009533
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DOI: https://doi.org/10.1007/BF03009533