复方利多卡因乳膏在双腔气管插管全身麻醉胸腔镜肺叶切除术中的应用——前瞻性随机对照研究
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摘要
目的探讨复方利多卡因(eutectic mixture of local anesthetics,EMLA)乳膏在双腔气管插管全身麻醉胸腔镜肺叶切除手术中应用的效果和安全性。方法采用随机、双盲(麻醉医生和患者对实验分组、流程、结果均不知情)、对照研究,选择2015年9月～2016年3月拟在我院择期全身麻醉下行胸腔镜肺叶切除术60例(ASAⅠ～Ⅱ级),随机分为2组:研究组(n=30)将EMLA乳膏2 g涂擦双腔气管插管套囊处;对照组(n=30)将EMLA基质白凡士林2 g涂擦双腔气管插管套囊处。主要观察病人苏醒拔管前咳嗽的发生率,可能造成气管导管移位时点的循环反应阳性发生率(动脉收缩压超过基础值15%定义为该时点循环反应阳性),不良事件的发生率。实验结束后揭盲,分组进行数据处理。结果研究组全麻苏醒期发生咳嗽5例(5/27),明显少于对照组16例(16/28)(χ~2=8. 688,P=0. 003)。2组T0、T1、T3血压未见明显差异;研究组T2、T4血压明显低于对照组(T2 SBP:t=-2. 056,P=0. 045; DBP:t=-2. 065,P=0. 044; T4 SBP:t=-2. 049,P=0. 045; DBP:t=-2. 274,P=0. 027)。研究组双腔气管插管相关循环反应阳性6例(6/27),明显少于对照组17例(17/28)(χ~2=8. 370,P=0. 004)。拔管后研究组气管黏膜轻度苍白,对照组气管黏膜正常。拔管后24 h内2组均无呼吸困难、喘鸣、喉痉挛、支气管痉挛、失声、饮水呛咳、误吸等不良事件发生。结论采用EMLA乳膏行气管内黏膜表面麻醉复合全身麻醉可以有效减轻双腔气管导管发生移位时对气管内膜的刺激,降低全麻苏醒期呛咳的发生率和麻醉过程中的循环反应阳性,对于预防双腔气管导管刺激而产生的不良反应是安全有效的。
Objective To evaluate the safety of eutectic mixture of local anesthetics(EMLA) cream in thoracoscopic lobectomy under general anesthesia with double-lumen endotracheal intubation. Methods In this randomized double-blind controlled study we enrolled 60 ASA physical status Ⅰ-Ⅱ patients who were scheduled for elective video-assisted thoracic surgical lobectomy.Patients were randomly divided into two groups. The double-lumen tube(DLT) cuff was lubricated with EMLA( experiment group,n=30) or with 2 g white vaseline( control group,n=30). The incidence of cough before extubation was observed. Positive rate of circulatory response at the time of possible tracheal tube displacement( defined as positive rate of circulatory response at the time when systolic blood pressure exceeded 15% of the baseline value) and incidence of adverse events were observed. Results In the experiment group,cough occurred in 5 cases(5/27) during the recovery period of general anesthesia,which was significantly less than16 cases(16/28) in the control group(χ~2= 8.688,P=0.003). There was no significant difference in blood pressure at T0,T1 and T3 between the two groups. The blood pressure at T2 and T4 in the experiment group was significantly lower than that in the control group(T2 SBP: t =-2. 056,P = 0. 045; DBP: t =-2. 065,P = 0. 044; T4 SBP: t =-2. 049,P = 0. 045; DBP: t =-2.274,P=0.027). There were 6 cases(6/27) of positive hemodynamic responses related to double-lumen intubation in the experiment group,which was significantly less than 17 cases(17/28) in the control group(χ~2=8.370,P=0.004). After extubation,the tracheal mucosa of the experiment group was slightly pale,while that of the control group was normal. Within 24 hours after extubation,no adverse events such as dyspnea,wheezing,laryngeal spasm,bronchospasm,aphonia,cough in drinking water or aspiration were observed in both groups. Conclusion Use of EMLA cream to the cuff of the DLT tube is a safe and effective method for preventing endotracheal tube-related hemodynamic responses and emergence coughing.
Objective To evaluate the safety of eutectic mixture of local anesthetics(EMLA) cream in thoracoscopic lobectomy under general anesthesia with double-lumen endotracheal intubation. Methods In this randomized double-blind controlled study we enrolled 60 ASA physical status Ⅰ-Ⅱ patients who were scheduled for elective video-assisted thoracic surgical lobectomy.Patients were randomly divided into two groups. The double-lumen tube(DLT) cuff was lubricated with EMLA( experiment group,n=30) or with 2 g white vaseline( control group,n=30). The incidence of cough before extubation was observed. Positive rate of circulatory response at the time of possible tracheal tube displacement( defined as positive rate of circulatory response at the time when systolic blood pressure exceeded 15% of the baseline value) and incidence of adverse events were observed. Results In the experiment group,cough occurred in 5 cases(5/27) during the recovery period of general anesthesia,which was significantly less than16 cases(16/28) in the control group(χ~2= 8.688,P=0.003). There was no significant difference in blood pressure at T0,T1 and T3 between the two groups. The blood pressure at T2 and T4 in the experiment group was significantly lower than that in the control group(T2 SBP: t =-2. 056,P = 0. 045; DBP: t =-2. 065,P = 0. 044; T4 SBP: t =-2. 049,P = 0. 045; DBP: t =-2.274,P=0.027). There were 6 cases(6/27) of positive hemodynamic responses related to double-lumen intubation in the experiment group,which was significantly less than 17 cases(17/28) in the control group(χ~2=8.370,P=0.004). After extubation,the tracheal mucosa of the experiment group was slightly pale,while that of the control group was normal. Within 24 hours after extubation,no adverse events such as dyspnea,wheezing,laryngeal spasm,bronchospasm,aphonia,cough in drinking water or aspiration were observed in both groups. Conclusion Use of EMLA cream to the cuff of the DLT tube is a safe and effective method for preventing endotracheal tube-related hemodynamic responses and emergence coughing.
引文
1 Hamaya Y,Dohi S. Differences in cardiovascular response to airway stimulation at different sites and blockade of responses by lidocaine.Anesthesiology,2000,93(1):95-103.
2 Biro P,Seifert B,Pasch T. Complaints of sore throat after tracheal intubation:a prospective evaluation. Eur J Anaesthesiol,2005,22(4):307-311.
3 Fang P,Zong Z,Lu Y,et al. Effect of topical ropivacaine on the response to endotracheal tube during emergence from general anesthesia:a prospective randomized double-blind controlled study.BMC Anesthesiol,2018,18(1):134-139.
4 Hernandez-Palazon J,Tortosa Serrano JA,Garcia-Palenciano C,et al. Cardiovascular response to tracheal intubation in patients with intracranial tumor. Comparative study between urapidil and lidocaine. Rev Esp Anestesiol Reanim,2000,47(4):146-150.
5 Chemik DA,Gillings D,Laine H,et al. Validity and reliability of the observer’s assessment of alertness/sedation scale:study with intravenous midazolam. J Clin Psychopharmacol,1990,10(4):244-251.
6 Minogue SC,Ralph J,Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from gene-ral anesthesia. Anesth Analg,2004,99(4):1253-1257.
7 Philbin DM, Rosow CE, Schneider RC, et al. Fentanyl and sufentanyl anesthesia revisited:how much is enough?Anesthesiology,1990,73(1):5-11.
8 Cheng YC,Li Y,Xu CT,et al. Effects of propofol versus urapidil on perioperative hemodynamics and intraocular pressure during anesthesia and extubation in ophthalmic patients. Int J Ophthalmol,2011,4(2):170-174.
9 Ugur B,Ogurlu M,Gezer E,et al. Effects of esmolol,lidocaine and fentanyl on haemodynamic responses to endotracheal intubation:a comparative study. Clin Drug Investig,2007,27(4):269-277.
10 Meng YF,Cui GX,Gao W,et al. Local airway anesthesia attenuates hemodynamic responses to intubation and extubation in hypertensive surgical patients. Med Sci Monit,2014,20(251):1518-1524.
11 Bousselmi R,Lebbi MA,Bargaoui A,et al. Lidocaine reduces endotracheal tube associated side effects when instilled over the glottis but not when used to inflate the cuff:a double blind,placebo-controlled,randomized trial. Tunis Med,2014,92(1):29-33.
12 Nath P,Williams S,Herrera Méndez LF,et al. Alkalinized lidocaine preloaded endotracheal tube cuffs reduce emergence cough after brief surgery:a prospective randomized trial. Anesth Analg,2018,126(2):615-620.
13 Ata N,Bülbül T,Demirkan A. Comparison of EMLA cream and lidocaine injection for local anaesthetic before radiofrequency reduction of the inferior turbinates. Br J Oral Maxillofac Surg,2017,55(9):917-920.
14 Rylander E,Sjberg I,Lillieborg S,et al. Local anesthesia of the genital mucosa with a lidocaine/prilocaine cream(EMLA)for laser treatment of condylomata acuminata:a placebo-controlled study.Obstet Gynecol,1990,75(2):302-306.
15 Effendy I,Gelber A,Lehmann P,et al. Plasma concentrations and analgesic efficacy of lidocaine and prilocaine in leg ulcer-related pain during daily application of lidocaine-prilocaine cream(EMLATM)for 10 days. Br J Dermatol,2015,173(1):259-261.
16 Larijani GE,Cypel D,Gratz I,et al. The efficacy and safety of EMLA? Cream for awake fiberoptic endotracheal intubation. Anesth Analg,2000,91(4):1024-1026.
17 Holst A,Evers H. Experimental studies of new topical anaesthetics on the oral mucosa. Swed Dent J,1985,9(5):185-191.
18 Jee D,Park SY. Lidocaine sprayed down the endotracheal tube attenuates the airway-circulatory reflexes by local anesthesia during emergence and extubation. Anesth Analg,2003,96(1):293-297.
19 Kumar M,Chawla R,Goyal M. Topical anesthesia. J Anaesthesiol Clin Pharmacol,2015,31(4):450-456.
20 Watson K. Astra markets cream to remove pain of injections. Pharm J,1986,237(3):262.
21 Kaweski SS. Topical anesthesia creams. Plast Reconstr Surg,2008,121(6):2161-2165.
22 Kluger N,Raison-Peyron N,Michot C,et al. Acute bullous irritant contact dermatitis caused by EMLA? cream. Contact Dermatitis,2011,65(3):181-183.
23 Timmermans MW,Bruynzeel DP,Rustemeyer T. Allergic contact dermatitis from EMLA cream:concomitant sensitization to both local anesthetics lidocaine and prilocaine. J Dtsch Dermatol Ges,2009,7(3):237-238.
24 van den Hove J,Decroix J,Tennstedt D,et al. Allergic contact dermatitis from prilocaine,one of the local anaesthetics in EMLA cream. Contact Dermatitis,1994,30(4):239.
2 Biro P,Seifert B,Pasch T. Complaints of sore throat after tracheal intubation:a prospective evaluation. Eur J Anaesthesiol,2005,22(4):307-311.
3 Fang P,Zong Z,Lu Y,et al. Effect of topical ropivacaine on the response to endotracheal tube during emergence from general anesthesia:a prospective randomized double-blind controlled study.BMC Anesthesiol,2018,18(1):134-139.
4 Hernandez-Palazon J,Tortosa Serrano JA,Garcia-Palenciano C,et al. Cardiovascular response to tracheal intubation in patients with intracranial tumor. Comparative study between urapidil and lidocaine. Rev Esp Anestesiol Reanim,2000,47(4):146-150.
5 Chemik DA,Gillings D,Laine H,et al. Validity and reliability of the observer’s assessment of alertness/sedation scale:study with intravenous midazolam. J Clin Psychopharmacol,1990,10(4):244-251.
6 Minogue SC,Ralph J,Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from gene-ral anesthesia. Anesth Analg,2004,99(4):1253-1257.
7 Philbin DM, Rosow CE, Schneider RC, et al. Fentanyl and sufentanyl anesthesia revisited:how much is enough?Anesthesiology,1990,73(1):5-11.
8 Cheng YC,Li Y,Xu CT,et al. Effects of propofol versus urapidil on perioperative hemodynamics and intraocular pressure during anesthesia and extubation in ophthalmic patients. Int J Ophthalmol,2011,4(2):170-174.
9 Ugur B,Ogurlu M,Gezer E,et al. Effects of esmolol,lidocaine and fentanyl on haemodynamic responses to endotracheal intubation:a comparative study. Clin Drug Investig,2007,27(4):269-277.
10 Meng YF,Cui GX,Gao W,et al. Local airway anesthesia attenuates hemodynamic responses to intubation and extubation in hypertensive surgical patients. Med Sci Monit,2014,20(251):1518-1524.
11 Bousselmi R,Lebbi MA,Bargaoui A,et al. Lidocaine reduces endotracheal tube associated side effects when instilled over the glottis but not when used to inflate the cuff:a double blind,placebo-controlled,randomized trial. Tunis Med,2014,92(1):29-33.
12 Nath P,Williams S,Herrera Méndez LF,et al. Alkalinized lidocaine preloaded endotracheal tube cuffs reduce emergence cough after brief surgery:a prospective randomized trial. Anesth Analg,2018,126(2):615-620.
13 Ata N,Bülbül T,Demirkan A. Comparison of EMLA cream and lidocaine injection for local anaesthetic before radiofrequency reduction of the inferior turbinates. Br J Oral Maxillofac Surg,2017,55(9):917-920.
14 Rylander E,Sjberg I,Lillieborg S,et al. Local anesthesia of the genital mucosa with a lidocaine/prilocaine cream(EMLA)for laser treatment of condylomata acuminata:a placebo-controlled study.Obstet Gynecol,1990,75(2):302-306.
15 Effendy I,Gelber A,Lehmann P,et al. Plasma concentrations and analgesic efficacy of lidocaine and prilocaine in leg ulcer-related pain during daily application of lidocaine-prilocaine cream(EMLATM)for 10 days. Br J Dermatol,2015,173(1):259-261.
16 Larijani GE,Cypel D,Gratz I,et al. The efficacy and safety of EMLA? Cream for awake fiberoptic endotracheal intubation. Anesth Analg,2000,91(4):1024-1026.
17 Holst A,Evers H. Experimental studies of new topical anaesthetics on the oral mucosa. Swed Dent J,1985,9(5):185-191.
18 Jee D,Park SY. Lidocaine sprayed down the endotracheal tube attenuates the airway-circulatory reflexes by local anesthesia during emergence and extubation. Anesth Analg,2003,96(1):293-297.
19 Kumar M,Chawla R,Goyal M. Topical anesthesia. J Anaesthesiol Clin Pharmacol,2015,31(4):450-456.
20 Watson K. Astra markets cream to remove pain of injections. Pharm J,1986,237(3):262.
21 Kaweski SS. Topical anesthesia creams. Plast Reconstr Surg,2008,121(6):2161-2165.
22 Kluger N,Raison-Peyron N,Michot C,et al. Acute bullous irritant contact dermatitis caused by EMLA? cream. Contact Dermatitis,2011,65(3):181-183.
23 Timmermans MW,Bruynzeel DP,Rustemeyer T. Allergic contact dermatitis from EMLA cream:concomitant sensitization to both local anesthetics lidocaine and prilocaine. J Dtsch Dermatol Ges,2009,7(3):237-238.
24 van den Hove J,Decroix J,Tennstedt D,et al. Allergic contact dermatitis from prilocaine,one of the local anaesthetics in EMLA cream. Contact Dermatitis,1994,30(4):239.