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The effect of epidural lidocaine administration on sedation of propofol general anesthesia: a randomized trial.
J Clin Anesth. 2014 Nov; 26(7):523-9.JC

Abstract

STUDY OBJECTIVE

To examine the influence of epidural and intravenous (IV) lidocaine, and height of the epidural sensory block, on the dose of propofol required for induction of general anesthesia.

DESIGN

Randomized controlled study.

SETTING

University hospital.

PATIENTS

66 adult, ASA physical status 1 and 2 patients, aged 25 to 65 years, undergoing elective abdominal surgery.

INTERVENTIONS

Patients were randomized to 4 groups: the epidural saline control group (Group C; L2-L3 puncture, epidural and IV saline), the IV lidocaine group (Group IV; L2-L3 puncture, saline epidural, IV lidocaine 1 mg/kg), the lumbar epidural lidocaine group (Group EL; L2-L3 puncture, 1.5% lidocaine epidural, IV saline), and the thoracic epidural lidocaine group (Group ET; T9-T10 puncture, 1.5%lidocaine epidural, IV saline). Two minutes after the beginning of the infusion of IV lidocaine or saline, propofol anesthesia was initiated.

MEASUREMENTS

Mean arterial blood pressure (MAP), heart rate (HR), and sensory block height were monitored. The induction dose of propofol, its estimated effect-site concentration (Ce), and plasma concentration were measured at various time points. Finally, we recorded the time taken for the bispectral index (BIS) to decrease to 60, the plasma concentration of lidocaine at induction, and the occurrence of adverse events. The induction time (when BIS reached 60) also was recorded.

MAIN RESULTS

The induction propofol dose, Ce, and plasma concentration of propofol when BIS equaled 60 were significantly lower in Group IV, Group EL, and Group ET than Group C. The above parameters in Group ET (T9 - T10 puncture) were significantly less than in Group EL (L2 - L3 puncture). The induction doses of propofol and plasma concentration of propofol and lidocaine were significantly higher in Group IV than in Groups EL or ET.

CONCLUSIONS

Epidural and IV lidocaine reduce the dose of propofol required to induce general anesthesia. Administration of lidocaine via the epidural route reduces anesthetic requirements more so than the IV route. Propofol requirements were further reduced in patients with higher sensory epidural block.

Authors+Show Affiliations

Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou 310003, People's Republic of China.Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou 310003, People's Republic of China.Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou 310003, People's Republic of China.Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou 310003, People's Republic of China.Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou 310003, People's Republic of China.Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou 310003, People's Republic of China. Electronic address: smzhu20088@163.com.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25439415

Citation

Xiang, Yan, et al. "The Effect of Epidural Lidocaine Administration On Sedation of Propofol General Anesthesia: a Randomized Trial." Journal of Clinical Anesthesia, vol. 26, no. 7, 2014, pp. 523-9.
Xiang Y, Chen CQ, Chen HJ, et al. The effect of epidural lidocaine administration on sedation of propofol general anesthesia: a randomized trial. J Clin Anesth. 2014;26(7):523-9.
Xiang, Y., Chen, C. Q., Chen, H. J., Li, M., Bao, F. P., & Zhu, S. M. (2014). The effect of epidural lidocaine administration on sedation of propofol general anesthesia: a randomized trial. Journal of Clinical Anesthesia, 26(7), 523-9. https://doi.org/10.1016/j.jclinane.2014.03.016
Xiang Y, et al. The Effect of Epidural Lidocaine Administration On Sedation of Propofol General Anesthesia: a Randomized Trial. J Clin Anesth. 2014;26(7):523-9. PubMed PMID: 25439415.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of epidural lidocaine administration on sedation of propofol general anesthesia: a randomized trial. AU - Xiang,Yan, AU - Chen,Chao-qin, AU - Chen,Han-jian, AU - Li,Mei, AU - Bao,Fang-ping, AU - Zhu,Sheng-mei, Y1 - 2014/10/16/ PY - 2012/09/06/received PY - 2014/03/10/revised PY - 2014/03/11/accepted PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2015/7/23/medline KW - Bispectral index KW - Epidural block KW - Epidural lidocaine KW - Propofol induction dose KW - Sedation SP - 523 EP - 9 JF - Journal of clinical anesthesia JO - J Clin Anesth VL - 26 IS - 7 N2 - STUDY OBJECTIVE: To examine the influence of epidural and intravenous (IV) lidocaine, and height of the epidural sensory block, on the dose of propofol required for induction of general anesthesia. DESIGN: Randomized controlled study. SETTING: University hospital. PATIENTS: 66 adult, ASA physical status 1 and 2 patients, aged 25 to 65 years, undergoing elective abdominal surgery. INTERVENTIONS: Patients were randomized to 4 groups: the epidural saline control group (Group C; L2-L3 puncture, epidural and IV saline), the IV lidocaine group (Group IV; L2-L3 puncture, saline epidural, IV lidocaine 1 mg/kg), the lumbar epidural lidocaine group (Group EL; L2-L3 puncture, 1.5% lidocaine epidural, IV saline), and the thoracic epidural lidocaine group (Group ET; T9-T10 puncture, 1.5%lidocaine epidural, IV saline). Two minutes after the beginning of the infusion of IV lidocaine or saline, propofol anesthesia was initiated. MEASUREMENTS: Mean arterial blood pressure (MAP), heart rate (HR), and sensory block height were monitored. The induction dose of propofol, its estimated effect-site concentration (Ce), and plasma concentration were measured at various time points. Finally, we recorded the time taken for the bispectral index (BIS) to decrease to 60, the plasma concentration of lidocaine at induction, and the occurrence of adverse events. The induction time (when BIS reached 60) also was recorded. MAIN RESULTS: The induction propofol dose, Ce, and plasma concentration of propofol when BIS equaled 60 were significantly lower in Group IV, Group EL, and Group ET than Group C. The above parameters in Group ET (T9 - T10 puncture) were significantly less than in Group EL (L2 - L3 puncture). The induction doses of propofol and plasma concentration of propofol and lidocaine were significantly higher in Group IV than in Groups EL or ET. CONCLUSIONS: Epidural and IV lidocaine reduce the dose of propofol required to induce general anesthesia. Administration of lidocaine via the epidural route reduces anesthetic requirements more so than the IV route. Propofol requirements were further reduced in patients with higher sensory epidural block. SN - 1873-4529 UR - https://www.unboundmedicine.com/medline/citation/25439415/The_effect_of_epidural_lidocaine_administration_on_sedation_of_propofol_general_anesthesia:_a_randomized_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0952-8180(14)00218-9 DB - PRIME DP - Unbound Medicine ER -