Hemodynamics Responses to Epinephrine and Lidocaine in Craniotomy Patients_West China Medical Journal

Authors：

SUN Yan , ZHANG Jingyu ,  LI Yu

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Yu, Email: yanzi8206@163.com

Keywords：

肾上腺素/利多卡因混合液; 开颅术头皮浸润法; 血压流动力学

DOI：

CNKI: 51-1356/R.20120214.1531.040

Video：

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目的　观察不同浓度肾上腺素与利多卡因混合液头皮浸润注射对开颅术患者血流动力学的影响。方法　选取2010年5月－10月80例颅内肿瘤患者，随机分成4组，行1%利多卡因溶液混合不同浓度的肾上腺素16 mL头皮浸润注射。肾上腺素浓度：A组2.5 μg/mL、B组5.0 μg/mL、C组7.5 μg/mL、D组10.0 μg/mL。记录注射前（T0）、注射后5 min内（T1-10）心率（HR）、平均动脉压（MAP）、收缩压（SBP）、舒张压（DBP），根据各时段的MAP最低值和最高值，计算MAP的降低率和升高率，计数各组MAP下降10%以内、10%～20%和20%以上的例数。结果　 C组的MAP下降例数最多且MAP下降率最高，与其他组间比较差异有统计学意义（P＜0.05）。组内比较，C组MAP、SBP在1.5、2.0、2.5 min时、DBP在2 min时和D组MAP和DBP在1.5、2.0 min时下降差异有统计学意义（P＜0.05）。4组血压下降的同时伴HR增快，但HR组间差异无统计学意义（P＞0.05）。结论　低浓度的肾上腺素与10%利多卡因混合液用于开颅术患者头皮浸润注射时可导致血压下降。

Citation： SUN Yan,ZHANG Jingyu,LI Yu. Hemodynamics Responses to Epinephrine and Lidocaine in Craniotomy Patients. West China Medical Journal, 2012, 27(2): 245-249. doi: CNKI: 51-1356/R.20120214.1531.040 Copy

1.	杨建军, 王忠云, 沈锦春, 等. 鼻内窥镜手术中局部浸润麻醉时肾上腺素引起的心血管反应[J]. 江苏医药, 2005, 31(11): 865-867.
2.	杨建军, 刘红军, 苏中宏, 等. 利多卡因混合不同剂量肾上腺素局部浸润麻醉对全麻下鼻内窥镜手术患者血液动力学的影响[J]. 中华麻醉学杂志, 2006, 26(5): 389-393.
3.	Muralidhar K, Bhanumurthy S. Attenuation of cardiovascular response to subcutaneous adrenaline in neurosurgical patients[J]. Br J Anaesth, 1992, 68(3): 264-267.
4.	胡益民, 李建生, 张转, 等. 浅全身麻醉减少头皮浸润注射肾上腺素引起的血压下降[J]. 医学研究生学报, 2008, 21(6): 607-610.
5.	Misra S, Koshy T, Suneel PR, et al. Oral clonidine attenuates the fall in mean arterial pressure due to scalp infiltration with epinephrine-lidocaine solution in patients undergoing craniotomy: a prospective, randomized, double-blind, and placebo controlled trial[J]. J Neurosurg Anesthesiol, 2009, 21(4): 297-301.
6.	Moss J, Glick D. The autonomic nervous system[M]//Miller RD, Miller’s Anesthesia. 6th ed. Edinburgh: Churchill Livingstone, 2005: 617-678.
7.	Murthy HS, Rao GS. Cardiovascular responses to scalp infiltration with diferent concentrations of epinephrine with or without lidocaine during cranlotomy[J]. Anesth Analg, 2001, 92(6): 1516-1519.
8.	Phillips S, Hutchinson SE, Bayly P, et al. Adrenaline-induced hypotension in neurosurgery[J]. Br J Anaesth, 1993, 70(6): 687-688.
9.	John G, Low JM, Tan PE, et al. Plasma eatecholamine levels during functional endoscopic sinus surgery[J]. Clin Otolaryngol Allied Sci, 1995, 20(3): 213-215.
10.	Homma Y, Ichinohe T, Kaneko Y. Oral mucosal blood flow,plasma epinephrine and hemodynamics responses after injection of lidocaine with epinephrine during midazolam sedation and isoflurane anaesthesia[J]. Br J Anaesth, 1999, 82(4) : 570-574.
11.	Yang JJ, Cheng HL, Shang RJ, et al. Hemodynamic changes due to infiltration of the scalp with epinephrine-containing lidocaine solution: a hypotensive episode before craniotomy[J]. J Neurosurg Anesthesiol, 2007,19(1): 31-37.
12.	Enlund M, MentelI O, Krekmanov L. Unintentional hypotension from lidocaine infiltration during orthognathic surgery and general anaesthesia[J]. Acta Anaesthesiol Scand, 200l, 45(3): 294-297.
13.	Moss J, Rein CL. The autonomic nervous system[M]//Miler RD. Anesthesia. 5th ed. New York: Churchill Livingstone, 2000: 523-577.
14.	Cotton BR, Henderson HP, Achola KJ, et al. Changes in plasma catecholamine concentrations following infiltration with large volumes of local anaesthetic solution containing adrenaline[J]. Br J Anaesth, 1986, 58(6): 593-597.
15.	Young WL, Ornstein E. Cerebral and spinal cord flow[M]//Cottrell JE, Smith DS. Anesthesia and neurosurgery. St.Louis: Mosby, 1994: 17-58.

1. 杨建军, 王忠云, 沈锦春, 等. 鼻内窥镜手术中局部浸润麻醉时肾上腺素引起的心血管反应[J]. 江苏医药, 2005, 31(11): 865-867.
2. 杨建军, 刘红军, 苏中宏, 等. 利多卡因混合不同剂量肾上腺素局部浸润麻醉对全麻下鼻内窥镜手术患者血液动力学的影响[J]. 中华麻醉学杂志, 2006, 26(5): 389-393.
3. Muralidhar K, Bhanumurthy S. Attenuation of cardiovascular response to subcutaneous adrenaline in neurosurgical patients[J]. Br J Anaesth, 1992, 68(3): 264-267.
4. 胡益民, 李建生, 张转, 等. 浅全身麻醉减少头皮浸润注射肾上腺素引起的血压下降[J]. 医学研究生学报, 2008, 21(6): 607-610.
5. Misra S, Koshy T, Suneel PR, et al. Oral clonidine attenuates the fall in mean arterial pressure due to scalp infiltration with epinephrine-lidocaine solution in patients undergoing craniotomy: a prospective, randomized, double-blind, and placebo controlled trial[J]. J Neurosurg Anesthesiol, 2009, 21(4): 297-301.
6. Moss J, Glick D. The autonomic nervous system[M]//Miller RD, Miller’s Anesthesia. 6th ed. Edinburgh: Churchill Livingstone, 2005: 617-678.
7. Murthy HS, Rao GS. Cardiovascular responses to scalp infiltration with diferent concentrations of epinephrine with or without lidocaine during cranlotomy[J]. Anesth Analg, 2001, 92(6): 1516-1519.
8. Phillips S, Hutchinson SE, Bayly P, et al. Adrenaline-induced hypotension in neurosurgery[J]. Br J Anaesth, 1993, 70(6): 687-688.
9. John G, Low JM, Tan PE, et al. Plasma eatecholamine levels during functional endoscopic sinus surgery[J]. Clin Otolaryngol Allied Sci, 1995, 20(3): 213-215.
10. Homma Y, Ichinohe T, Kaneko Y. Oral mucosal blood flow,plasma epinephrine and hemodynamics responses after injection of lidocaine with epinephrine during midazolam sedation and isoflurane anaesthesia[J]. Br J Anaesth, 1999, 82(4) : 570-574.
11. Yang JJ, Cheng HL, Shang RJ, et al. Hemodynamic changes due to infiltration of the scalp with epinephrine-containing lidocaine solution: a hypotensive episode before craniotomy[J]. J Neurosurg Anesthesiol, 2007,19(1): 31-37.
12. Enlund M, MentelI O, Krekmanov L. Unintentional hypotension from lidocaine infiltration during orthognathic surgery and general anaesthesia[J]. Acta Anaesthesiol Scand, 200l, 45(3): 294-297.
13. Moss J, Rein CL. The autonomic nervous system[M]//Miler RD. Anesthesia. 5th ed. New York: Churchill Livingstone, 2000: 523-577.
14. Cotton BR, Henderson HP, Achola KJ, et al. Changes in plasma catecholamine concentrations following infiltration with large volumes of local anaesthetic solution containing adrenaline[J]. Br J Anaesth, 1986, 58(6): 593-597.
15. Young WL, Ornstein E. Cerebral and spinal cord flow[M]//Cottrell JE, Smith DS. Anesthesia and neurosurgery. St.Louis: Mosby, 1994: 17-58.

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