Abstract
Purpose
Tracheal extubation produces haemodynamic changes that may cause myocardial ischaemia in patients with coronary arterial disease. Intravenous infusion of prostaglandin El (PGE1) attenuated the hypertensive response to tracheal extubation but failed to blunt the tachycardia, which was attenuated by intravenous lidocaine. Thus, we investigated whether a combination of PGE, and lidocaine can overcome the drawbacks of treatment with PGE1, alone.
Methods
One hundred adult patients (ASA 1) undergoing elective minor surgery were randomly assigned to receive one of four treatments: saline (as a control), I mg·kg−1 lidocaine, infusion of 0.1 μg−1·kg−1·min−1 PGE1, or infusion of 0.1 μg−1·kg−1 min−1 PGE1 plus injection of I mg−1·kg/−1 lidocaine. Lidocaine was injected two minutes before tracheal extubation. The PGE, was infused from completion of surgery until five minutes after tracheal extubation. Anaesthesia was maintained with sevoflurane 1.0%–2.5% and nitrous oxide 60%. Heart rate (HR) and blood pressure (BP) were measured before and after tracheal extubation.
Results
Lidocaine alone and PGE1-lidocaine combination attenuated the increases in BP and HR observed in the control group: PGE1 alone was effective in attenuating hypertensive response but ineffective for tachycardia. The suppressive effect of the PGE1 -lidocaine combination on BP increase was superior to that of each drug alone, and the combined effect on HR increase was similar to that of lidocaine alone.
Conclusion
The combination of PGE1 infusion and lidocaine is a more effective method of attenuating hypertension and tachycardia associated with tracheal extubation than either drug alone.
Résumé
Objectif
Les changements hémodynamiques provoqués par l’extubation de la trachée peuvent induire de l’ichémie myocardique chez les insuffisants coronariens. On a montré que la perfusion intraveineuse de prostaglandine E1 (PGE1) atténuait la réaction hypertensive à l’extubation sans dimunier la tachycardie qui répond à la lidocaïne intraveineuse. Nous avons recherché si l’association PGE1-lidocaïne pouvait surmonter les inconvénients de la PGE1 seule.
Méthodes
Cent adultes (ASA I) opérés pour une chirurgie mineure non urgente ont été répartis aléatoirement pour recevoir un des quatre traitements suivants: sol.phys. (contrôle), lidocaïne I mg·kg−1. PGE1 0.1 mg·kg−1·min−1 en perfusion, ou PGE1 0.1 mg·kg−1·min−1 en perfusion avec une injection de lidocaïne I mg·kg−1 deux minutes avant l’extubation. La perfusion de PGE1 débutait à la fin de la chirurgie et finissait après l’extubation. L’anesthésie était entretenue avec du sévoflurane 1.0%–2.5% et du protoxyde d’azote 60%. On mesurait la fréquence cardiaque (FC et la tension arténelle (TA) avant et après l’extubation.
Résultats
La lidocaïne seule et l’association PGE1-lidocaïne atténuaient l’augmentation de la TA et de la FC observée dans le groupe contrôle; la PGE1 seule atténuait efficacement la réaction hypertensive mais non la tachycardie. L’association PGE1-lidocaïne contrôlait mieux l’élévation de la TA que l’un ou l’autre des deux produit administrés seuls, et avait un effet identique à la lidocaïne seule sur l’augmentation de la FC.
Conclusion
Une perfusion de PGE1 associée à de la lidocaïne atténue plus efficacement l’hypertension et la tachycardie provoquées par l’extubation de la trachée que l’un ou l’autre des produits administré seul.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Hartley M, Vaughan RS. Problems associated with tracheal extubation. Br J Anaesth 1993; 71: 561–8.
Bidwai AV, Bidwai VA, Rogers CR, Stanley TH. Bloodpressure and pulse-rate responses to endotracheal extubation with and without prior injection of lidocaine. Anesthesiology 1979; 51: 171–3.
Nishina K, Mikawa K, Maekawa N, Obara H. Fentanyl attenuates cardiovascular responses to tracheal extubation. Acta Anaesthesiol Scand 1995; 39: 85–9.
Mikawa K, Nishina K, Maekawa N, Obara H. Attenuation of cardiovascular responses to tracheal extubation: verapamil versus diltiazem. Anesth Analg 1996; 82: 1205–10.
Nishina K, Mikawa K, Maekawa N, Obara H. Attenuation of cardiovascular responses to tracheal extubation with diltiazem. Anesth Analg 1995; 80: 1217–22.
Nishina K, Mikawa K, Shiga M, Maekawa N, Obara H. Prostaglandin E1 attenuates the hypertensive response to tracheal extubation. Can J Anaesth 1996; 43: 678–83.
Braunwald E. Control of myocardial oxygen consumption. Physiologic and clinical considerations. Am J Cardiol 1971; 27: 416–32.
Kaplan JA, King SB. The precordial electrocardiographic lead (V5) in patients who have coronary-artery disease. Anesthesiology 1976; 45: 570–4.
Slogoff S, Keats AS. Does perioperative myocardial ischemia lead to postoperative myocardial infarction? Anesthesiology 1985; 62: 107–14.
Sill JC Prevention and treatment of myocardial ischemia and dysfunction.In: Tarhan S (Ed.). Anesthesia and Coronary Artery Surgery. Chicago: Year Book Medical Publishers, 1986: 218–68.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nishina, K., Mikawa, K., Takao, Y. et al. Prostaglandin E1, lidocaine, and prostaglandin E1-lidocaine combination for attenuating cardiovascular responses to extubation. Can J Anesth 44, 1211–1214 (1997). https://doi.org/10.1007/BF03013348
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03013348