Taju Nisha, V (2017) Evaluation of the effect of intravenous lidocaine on propofol requirements during general anaesthesia, as measured by the bi spectral (BIS) index. Masters thesis, Madurai Medical College, Madurai.
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Abstract
AIM OF THE STUDY: To evaluate the effect of intravenous lidocaine in reducing propofol requirements during maintenance of general anesthesia in laparoscopic cholecystectomies, as monitored by the Bi Spectral (BIS) index — A Randomized controlled double-blinded study. MATERIALS AND METHODS: After obtaining approval from our Government Rajaji Hospital (GRH) ethical committee, we conducted a randomized double-blinded controlled trial enrolling 40 patients, aged 18-60 years of ASA I and II physical status, undergoing elective laparoscopic elective cholecystectomy, without any history of allergy to the drugs used in the study. Informed written consent was obtained from all the patients and they were then randomly allocated into two groups of 20 each, namely Group L and Group C. After connecting the monitors: NIBP, pulseoximetry, BIS and ECG, patient is premedicated with Inj. Glcopyrrolate sodium 0.2 mg i.v. followed by preoxygenation with 100% oxygen. Anesthesia is induced with Inj. Fentanyl citrate 2µg/kg i.v. followed after 3 minutes by Inj. Propofol 1.5-2.5 mg/kg. After loss of consciousness defined by BIS of 45, i.v. succinylcholine is administered and the patient is intubated. The patients in the lidocaine group (Group L) will receive 1% i.v. lidocaine (1.5mg/kg over 5 min followed by 2 mg/kg/hour), and the control group (Group C) will receive an equal volume of 0.9% saline. The parameters monitored were the hemodynamic variables, namely heart rate, blood pressure. The intraoperative BIS values were recorded throughout the procedure. The amount of propofol used to maintain the BIS value between 40 and 60 was recorded. The intraoperative fentanyl requirements were also recorded. Statistical analysis of the data was done using Student t test and Chi square test. RESULTS: The results of the study showed that the amount of propofol infused in the lidocaine group, to maintain BIS between 40 and 60 was significantly reduced, and also the intraoperative fentanyl requirements were significantly lower in the lidocaine group. Otherwise, the hemodynamic variables did not show significant variation between the two groups, except during the first few minutes after intubation when the heart rate increase to pressor response was significantly reduced in the lidocaine group. CONCLUSION: Thus, our study concluded that intravenous lidocaine in the form of bolus followed by infusion reduces the propofol requirements to maintain BIS between 40 and 60, which is required to prevent intraoperative awareness and recall. It also significantly maintains the hemodynamic stability throughout the procedure and reduces the intraoperative analgesic requirements in patients undergoing laparoscopic surgeries. The above effects of lidocaine have been attributed to its inflammatory-modulating property and also to its effect on the central nervous system where it reduces the cerebral metabolic oxygen consumption (CMRO2).
| Item Type: | Thesis (Masters) |
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| Additional Information: | Reg.No.201420105 |
| Uncontrolled Keywords: | propofol, bispectral index, lidocaine, fentanyl, laparoscopic cholecystectomy, hemodynamic, awareness in anesthesia. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 21 Jul 2020 01:53 |
| Last Modified: | 21 Jul 2020 01:53 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/12596 |
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