LElCHT P, WISBORG T, Does intravenous lidocaine prevent laryngospasm after extubation in children? Anesth Analg 1985;64:1193-6. CHRAEMMER-JBRGENSEN B.One huridred otherwise healthy children undergoing tonsillectomy were investigated in a double-blind study to exaiizine the effect of intrazienous lidocaine in preventiiig laryngospasni upon extubation. The children were anesthetized with N,O-0,-halothaize and orally intubated. They were raridonzly given lidocaine, 1.5 mglkg, or saliiie intrazleiiously prior to extubation, which took place at the same depth of anesthesia, izanrcly wheii there were signs of s z t d lozi1iiig activity. Eleven childreiz ( 2 % ) in each group of 50 dez~eloped laryngospasm. Froiii our findings it is coiicluded that lidocaine, I .5 nzglkg, does not prevent laryngospasm upori extubation zuhen extubatioil is carried out at the start of swallowing activity.Intravenous lidocaine has been shown to suppress effectively persistent cough caused by bronchoscopy (1). Lidocaine, given topically to the larynx and trachea (2) or intravenously (3), has been shown to blunt the increases in heart rate and blood pressure associated with laryngoscopy and endotracheal intubation. The data of Hamill et al. (4) indicated that lidocaine prevented intracranial hypertension after intubation and also limited the intensity and duration of cardiovascular stimulation. Furthermore, they showed that the intravenous route was the preferred technique for administering lidocaine. Bidwai et al.(5) demonstrated that intravenous lidocaine prevented coughing and increases in blood pressure and heart rate during and after endotracheal extubation. Adenotonsillectomy, a brief surgical procedure, can present major acute problems of bleeding, airway obstruction, and cardiac arrhythmias. As a consequence, the patient must have a rapid return to responsiveness with intact protective airway reflexes before tracheal extubation. Occasionally, this procedure is followed by laryngospasm, a serious complication, which is almost always associated with airway manipulation by the anesthesiologist or with the presence of foreign material in the larynx of the lightly anesthetized patient. In an open study including 40 children undergoing tonsillectomy, Baraka (6) showed that intravenous lidocaine prevented extubation laryngospasm. The purpose of this controlled clinical trial using doubleblind technique was, therefore, to confirm or reject the asserted prophylactic effect of lidocaine against laryngospasm after tracheal extubation. Material and MethodsOne hundred otherwise healthy children older than 1 yr of age and with a body weight less than 40 kg scheduled for elective tonsillectomy under general anesthesia participated in the study. Children with known hypersensitivity to lidocaine were not included. The study protocol was approved by the Copenhagen County Human Investigation Committee. Informed consent was obtained from the parents of all participating children.All the children were premedicated half an hour prior to expected induction ...
We have studied the effect of 1 or 2 MAC isoflurane with or without ketanserin on cerebral blood flow (CBF), cerebral oxygen metabolism (CMRO2) and CBF autoregulation in 20 adult patients undergoing lumbar disc surgery. Ten patients received ketanserin and 10 isotonic saline. CBF measurements were started after 1 h of infusion of saline or ketanserin. The patients were anaesthetized with thiopentone 5 mg kg-1 followed by isoflurane. During 1 MAC of isoflurane, baseline values were recorded and then CBF autoregulation was examined (mean arterial pressure increased by about 30% with angiotensin). The sequence was repeated with 2 MAC of isoflurane. CBF was measured by the i.v. xenon-133 technique. CMRO2 was calculated as the product of CBF and the cerebral arterio-venous oxygen content difference. Ketanserin had no effect on CBF, CMRO2 or CBF autoregulation during isoflurane anaesthesia, therefore all patients were pooled for evaluation of the effect of isoflurane. Increasing isoflurane anaesthesia from 1 to 2 MAC increased mean CBF from 41 to 49 ml/100 g min-1 (P < 0.01) and decreased mean CMRO2 from 1.5 to 1.1 ml/100 g min-1 (P < 0.001) and thus abolished the coupling between flow and metabolism. The CBF autoregulation test indicated that autoregulation was disrupted at 2 MAC, but not during 1 MAC isoflurane anaesthesia.
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