季瑋珠臺灣大學：預防醫學研究所孫孝倫Sun, Hsiao-LunHsiao-LunSun2007-11-282018-06-292007-11-282018-06-292006http://ntur.lib.ntu.edu.tw//handle/246246/59209背景：研究顯示，口咽置入局部麻醉劑lidocaine，可降低光纖內視鏡清醒插管時的循環反應。本研究嘗試將此一局部麻醉效果，延伸用於麻醉誘導插管時。 目的：本研究在探討全身麻醉誘導期，插管前給予口咽置入局部麻醉劑2% lidocaine 5 ml，能否改善血壓和心率對氣管插管的反應。 材料和方法： 56位接受常規預定手術之成年病患被隨機分成二組，實驗組病患在全身麻醉誘導後45秒，於口咽置入局部麻醉劑2% lidocaine 5 mL，造成口咽及氣管表皮麻醉；對照組病患在全身麻醉誘導後45秒，於口咽置入生理鹽水5 mL。三分鐘後，給予受試者氣管插管，期間每分鐘監測受試者之血壓 (收縮壓、舒張壓、平均血壓) 和心率。口咽置入局部麻醉劑後，連續監測受試者每分鐘之血壓和心率達六分鐘。將兩組氣管插管後一分鐘之血壓和心率，以及其與基礎值之變動，以非配對 t-試驗比較，以確定口咽置入局部麻醉劑lidocaine，對降低氣管插管時循環反應的效果。 結果：在氣管插管後一分鐘之血壓和心率，lidocaine 組均比對照組為低(P < 0.05)。氣管插管後一分鐘之收縮壓、舒張壓、平均血壓與基礎值之變動差在對照組均較高 (P < 0.001)，然而心率變動差兩組並無差異。 結論：氣管插管前口咽置入局部麻醉劑lidocaine，可以降低因插管時刺激造成之心率及血壓的上升的循環反應。此為一簡單又有效，可以局部麻醉上呼吸道的方法，能使麻醉誘導及氣管插管時的循環反應較為平穩。Purpose: This study attempts to determine whether oropharyngeal instillation of 5mL of 2% lidocaine for 3 min before intubation modifies changes in heart rate (HR) and blood pressure (BP) responses to the stimulation. Materials and methods: Fifty-six surgical patients were randomized to receive oropharyngeal instillation with either 5 mL of 2% lidocaine (lidocaine group) or 5 mL of normal saline (control group) 45 s after induction bolus. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and HR were recorded every min thereafter for 6 min. Laryngoscopy and intubation was attempted at 3 min after intervention. The 1-min postintubation values of HR, SBP, DBP, and MBP between the groups, and their changes from baseline were compared as a priori using the unpaired t-test. Results: The 1-min postintubation values of SBP, DBP, MBP, and HR were significantly lower in the lidocaine group as compared to the control group (P < 0.05). The differences in mean values of SBP, DBP, and MBP changes from baseline were significantly greater in the control group (P ≤ 0.001), while that of HR was not significant. More patients (P < 0.001) become hypertensive at 1-min postintubation in the control group than in the lidocaine group. No differences in tachycardia incidence were found. Conclusion: We conclude that oropharyngeal administration of lidocaine before intubation attenuates the cardiovascular responses to the stimulation. It is a simple and effective method for achieving anesthesia of the upper airway and rendering induction smoother with respect to cardiovascular changes.Contents Abstract p.5 中文摘要 p.7 Chapter 1. Introduction p.8 Chapter 2. Rationale and hypotheses p.11 1.Rationale of this study p.11 2.Hypothesis and specific objectives p.12 Chapter 3. Literature review p.13 1. Intravenous lidocaine and cardiovascular response to intubation p.14 2. Laryngotracheal lidocaine and cardiovascular response to intubation p.18 3.Summary p.23 Chapter 4. Materials and methods p.30 1.General study design p.30 2.Study population p.30 3.Randomization p.30 4.Methods p.31 5.Data recording p.32 6.Sample size calculation p.32 7.Statistical analysis p.33 Chapter 5. Results p.35 Chapter 6. Discussion p.40 1.Major findings 2.Comparison with previous studies p.40 3.Possible mechanism p.42 4.Methodological consideration p.42 5.Strengths p.45 6.Limitations p.45 7.Further perspectives p.46 8.Conclusion p.47 References p.48 Appendix Approval of the Institutional Review Board of Cathay General Hospital p.53 Tables and Figures List Table 3-1. Prospective studies on intravenous lidocaine and response to intubation p.25 Table 3-2. Prospective studies on laryngotracheal lidocaine and response to intubation p.27 Table 5-1. Characteristics of the patients and baseline variables p.36 Table 5-2. Hemodynamic variables at 1-min postintubation between the groups p.37 Table 5-3. Postintubation circulatory changes from baseline in each group p.38 Figure 4-1. Study design flow chart p.34 Figure 5-1. Heart rate and blood pressure changes from baseline p.39en-US呼吸道氣管插管麻醉劑：lidocaine血壓心率anesthetic techniques: intubationlaryngoscopyanestheticslocallidocainehemodynamics: blood pressureheart ratethesis