Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.08.005
Brazilian Journal of Anesthesiology
Scientific Article

Effects of lidocaine and esmolol infusions on hemodynamic changes, analgesic requirement, and recovery in laparoscopic cholecystectomy operations

Efeitos das infusões de lidocaína e esmolol sobre as alterações hemodinâmicas, necessidade de analgésicos e recuperação após colecistectomia laparoscópica

Serpil Dagdelen Dogan; Faik Emre Ustun; Elif Bengi Sener; Ersin Koksal; Yasemin Burcu Ustun; Cengiz Kaya; Fatih Ozkan

http://dx.doi.org/10.1016/j.bjane.2014.08.005 Braz J Anesthesiol, vol.66, n2, p.145-150, 2016
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Abstract

ABSTRACT OBJECTIVE: We compared the effects of lidocaine and esmolol infusions on intraoperative hemodynamic changes, intraoperative and postoperative analgesic requirements, and recovery in laparoscopic cholecystectomy surgery. METHODS: The first group (n = 30) received IV lidocaine infusions at a rate of 1.5 mg/kg/min and the second group (n = 30) received IV esmolol infusions at a rate of 1 mg/kg/min. Hemodynamic changes, intraoperative and postoperative analgesic requirements, and recovery characteristics were evaluated. RESULTS: In the lidocaine group, systolic arterial blood pressures values were lower after the induction of anesthesia and at 20 min following surgical incision (p < 0.05). Awakening time was shorter in the esmolol group (p < 0.001); Ramsay Sedation Scale scores at 10 min after extubation were lower in the esmolol group (p < 0.05). The modified Aldrete scores at all measurement time points during the recovery period were relatively lower in the lidocaine group (p < 0.05). The time to attain a modified Aldrete score of ≥9 points was prolonged in the lidocaine group (p < 0.01). Postoperative resting and dynamic VAS scores were higher in the lidocaine group at 10 and 20 min after extubation (p < 0.05, p < 0.01, respectively). Analgesic supplements were less frequently required in the lidocaine group (p < 0.01). CONCLUSION: In laparoscopic cholecystectomies, lidocaine infusion had superiorities over esmolol infusions regarding the suppression of responses to tracheal extubation and postoperative need for additional analgesic agents in the long run, while esmolol was more advantageous with respect to rapid recovery from anesthesia, attenuation of early postoperative pain, and modified Aldrete recovery (MAR) scores and time to reach MAR score of 9 points.

Keywords

Lidocaine, Esmolol, Recovery, Laparoscopic cholecystectomy

Resumo

RESUMO OBJETIVO: Comparar os efeitos de infusões de lidocaína e esmolol sobre as alterações hemodinâmicas no período intraoperatório, a necessidade de analgésicos intra- e pós-operatoriamente e a recuperação após colecistectomia laparoscópica. MÉTODOS: O primeiro grupo (n = 30) recebeu infusões IV de lidocaína a uma taxa de 1,5 mg/kg/min e o segundo grupo (n = 30) recebeu infusões IV de esmolol a uma taxa de 1 mg kg/min. Alterações hemodinâmicas, necessidade de analgésicos no intra- e pós-operatório e características da recuperação foram avaliadas. RESULTADOS: No grupo lidocaína, os valores da pressão arterial sistólica foram menores após a indução da anestesia e 20 minutos após a incisão cirúrgica (p < 0,05). O tempo até o despertar foi menor no grupo esmolol (p < 0,001), os escores na escala de Sedação de Ramsay 10 minutos após a extubação foram menores no grupo esmolol (p < 0,05). Os escores de Aldrete modificados em todos os tempos mensurados durante o período de recuperação foram relativamente baixos no grupo lidocaína (p < 0,05). O tempo necessário para atingir um escore de Aldrete ≥ 9 pontos foi prolongado no grupo lidocaína (p < 0,01). Os escores Eva em repouso e em movimento no pós-operatório foram maiores no grupo lidocaína nos minutos 10 e 20 após a extubação (p < 0,05,p < 0,01, respectivamente). Analgésicos suplementares foram necessários com menos frequência no grupo lidocaína (p < 0,01). CONCLUSÃO: Em colecistectomia laparoscópica, a infusão de lidocaína foi superior às infusões de esmolol quanto a suprimir as respostas à extubação traqueal e necessidade de analgésicos adicionais no pós-operatório, enquanto esmolol foi mais vantajoso quanto à rápida recuperação da anestesia, à atenuação da dor no pós-operatório imediato e aos escores de recuperação de Aldrete modificado (RAM) e o tempo até atingir o escore RAM de 9 pontos.

Palavras-chave

Lidocaina, Esmolol, Recuperação, Colecistectomia laparoscópica

References

Min JH, Chai HS, Kim YH. Attenuation of hemodynamic responses to laryngoscopy and tracheal intubation during rapid sequenceinduction remifentanil vs. lidocaine with esmolol. Minerva Anestesiol. 2010;76:188-92.

Cook TM, MacDougall-Davis SR. Complications and failure of airway management. Br J Anaesth. 2012;109(Suppl. 1):i68-85.

Kaplan JD, Schuster DP. Physigolic consequences of tracheal intubation. Clin Chest Med. 1991;12:425-32.

Benumof JL, Saidman LJ. Management of the airway complications. Anesthesia and perioperative complications. 1999:1-21.

Capuzzo M, Verri M, Alvisi R. Hemodynamic responses to laryngoscopy and intubation etiological or symptomatic prevention?. Minerva Anestesiol. 2010;76:173-4.

Wu CT, Borel CO, Lee MS. The interaction effect of perioperative cotreatment with dextromethorphan and intravenous lidocaine on pain relief and recovery of bowel function after laparoscopic cholecystectomy. Anesth Analg. 2005;100:448-53.

Lauwick S, Kim DJ, Michelagnoli G. Intraoperative infusion of lidocaine reduces postoperative fentanyl requirements in patients undergoing laparoscopic cholecystectomy. Can J Anesth. 2008;55:754-60.

Menigaux C, Guignard B, Adam F. Esmolol prevents movement and attenuates the BIS response to orotracheal intubation. Br J Anaesth. 2002;89:857-62.

Tas¸yuz T, Topçu I, Ozaslan S. Effects of esmolol on hemodynamic responses to laryngoscopy and tracheal intubation in diabetic versus non-diabetic patients. Turk J Med Sci. 2007;37:289-96.

Wiest DB, Haney JS. Clinical pharmacokinetics and therapeutic efficacy of esmolol. Clin Pharmacokinet. 2012;51:347-56.

Collard V, Mistraletti G, Taqi A. Intraoperative esmolol infusion in the absence of opioids spares postoperative fentanyl in patients undergoing ambulatory laparoscopic cholecystectomy. Anesth Analg. 2007;105:1255-62.

Coloma M, Chiu JW, White PF. The use of esmolol as an alternative to remifentanyl during desfluran anesthesia for fast-track outpatient gynecologic laparoskopic surgery. Anesth Analg. 2001;92:352-7.

Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy a critical assessment of the evidence. Anesthesiology. 2006;104:835-46.

Werawatganon T, Charuluxananan S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intraabdominal surgery. Cochrane Database Syst Rev. 2013;28:CD004088.

Chia YY, Chan MH, Ko NH. Role of - blockade in anaesthesia and postoperative pain management after hysterectomy. Br J Anaesth. 2004;93:799-805.

White PF, Wang B, Tang J. The effect of intraoperative use of esmolol and nicardipine on recovery after ambulatory surgery. Anesth Analg. 2003;97:1633-8.

Topcu I, Ozturk T, Tasyuz T. The effects of esmolol on anesthetic and analgesic requirement. Turk J Anaesth Reanim. 2007;35:393-8.

Keskin E, Bilgin H. Comparing the effects of lidocaine and esmolol for the control of hemodynamic responses during laryngoscopy, intubation and extubation. Turk J Anaesth Reanim. 2005;33:463-70.

Koppert W, Weigand M, Neumann F. Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. Anesth Analg. 2004;98:1050-5.

Smith I, Hemelrijck JV, White PF. Efficacy of esmolol versus alfentanil as a supplement to propofol-nitrous oxide anesthesia. Anesth Analg. 1991;73:540-6.

Ozturk T, Kaya H, Aran G. Postoperative beneficial effects of esmolol in treated hypertensive patients undergoing laparoscopic cholecystectomy. Br J Anaesth. 2008;100:211-4.

Pypendop BH, Ilkiw JE. The effects of intravenous lidocaine administration on the minimum alveolar concentration of isoflurane in cats. Anesth Analg. 2005;100:97-101.

Joris JL. Anesthesia for laparoscopic surgery. Anesthesia. 2009:2185-203.

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