복강경 담낭절제술 시 공기배증 전에 주입한 복강 내 lidocaine의 공기배증 후 혈압상승 완화효과
Attenuation of pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum in laparoscopic cholecystectomy
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Background: We have previously found that intra-peritoneal lidocaine instillation before pneumoperitoneum attenuates pneumoperitoneum-induced hypertension. Whether this procedure alters patient’s hemodynamic status during operation should be determined for clinical application. This study elucidated the possible mechanism of the attenuation of the pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum. Methods: Thirty-four patients underwent laparoscopic cholecystectomy (LC) were randomly allocated into two groups. After induction of general anesthesia, 200 mL of 0.2% lidocaine (lidocaine group, n=17), or normal saline (control group, n=17) were sub-diaphragmatically instilled 10 minutes before pneumoperitoneum. The changes in systolic blood pressure, heart rate, central venous pressure, stroke volume, cardiac output, and systemic vascular resistance were compared between the groups. The number of analgesics used during post-operative 24 h was compared. Results: Systolic blood pressure was elevated during pneumoperitoneum in both groups (p<0.01), but the degree of elevation was significantly reduced in the lidocaine group than in the control (p<0.01). However, stroke volume and cardiac output were decreased and systemic vascular resistance was increased after induction of pneumoperitoneum (p<0.05) without statistical difference between two groups. The number of analgesics used was significantly reduced in the lidocaine group (p<0.01). Conclusion: These data suggest that intra-peritoneal lidocaine before pneumoperitoneum does not alter patient’s hemodynamics, and attenuation of pneumoperitoneum-induced hypertension may be the consequence of reduced intra-abdominal pain rather than the decrease of cardiac output during pneumoperitoneum. Therefore, intra-peritoneal lidocaine instillation before pneumoperitoneum is a useful method to manage an intraoperative pneumoperitoneum-induced hypertension and to control postoperative pain without severe detrimental hemodynamic effects.
Abstract
Background: We have previously found that intra-peritoneal lidocaine instillation before pneumoperitoneum attenuates pneumoperitoneum-induced hypertension. Whether this procedure alters patient’s hemodynamic status during operation should be determined for clinical application. This study elucidated the possible mechanism of the attenuation of the pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum. Methods: Thirty-four patients underwent laparoscopic cholecystectomy (LC) were randomly allocated into two groups. After induction of general anesthesia, 200 mL of 0.2% lidocaine (lidocaine group, n=17), or normal saline (control group, n=17) were sub-diaphragmatically instilled 10 minutes before pneumoperitoneum. The changes in systolic blood pressure, heart rate, central venous pressure, stroke volume, cardiac output, and systemic vascular resistance were compared between the groups. The number of analgesics used during post-operative 24 h was compared. Results: Systolic blood pressure was elevated during pneumoperitoneum in both groups (p<0.01), but the degree of elevation was significantly reduced in the lidocaine group than in the control (p<0.01). However, stroke volume and cardiac output were decreased and systemic vascular resistance was increased after induction of pneumoperitoneum (p<0.05) without statistical difference between two groups. The number of analgesics used was significantly reduced in the lidocaine group (p<0.01). Conclusion: These data suggest that intra-peritoneal lidocaine before pneumoperitoneum does not alter patient’s hemodynamics, and attenuation of pneumoperitoneum-induced hypertension may be the consequence of reduced intra-abdominal pain rather than the decrease of cardiac output during pneumoperitoneum. Therefore, intra-peritoneal lidocaine instillation before pneumoperitoneum is a useful method to manage an intraoperative pneumoperitoneum-induced hypertension and to control postoperative pain without severe detrimental hemodynamic effects.
참고문헌 (32)
- Voyles CR, "Selection criteria for laparoscopic cholecystectomy in an ambulatory care setting", Surg Endosc, 11, pp.1145~1146 (1997)
- Joris JL, "Hemodynamic changes during laparoscopic cholecystectomy", Anesth Analg, 76, pp.1067~1071 (1993)
- Odeberg S, "Haemodynamic effects of pneumoperitoneum and the influence of posture during anaesthesia for laparoscopic surgery", Acta Anaesthesiol Scand, 38, pp.276~283 (1994)
- Wahba RW, "Cardiopulmonary function and laparoscopic cholecystectomy", Can J Anaesth, 42, pp.51~63 (1995)
- Walder AD, "Role of vasopressin in the haemodynamic response to laparoscopic cholecystectomy", Br J Anaesth, 78, pp.264~266 (1997)
- Mann C, "The relationship among carbon dioxide pneumoperitoneum, vasopressin release, and hemodynamic changes", Anesth Analg, 89, pp.278~283 (1999)
- Yeo JE, "Effects of the methods of general anesthesia on the changes of blood prssure and arterial carbon dioxide tension during laparoscopic chosecystectomy", Korean J Anesthesiol, 28, pp.534~540 (1995)
- 송선옥, "복강경 담낭절제술을 위한 마취 관리", Korean Journal of Anesthesiology, 47(1), pp.1~11 (2004), 대한마취통증의학회
- 송선옥, "복강경 담낭절제술시 기복증 유도전 복강내 Lidocaine 점적주입이 술 후 통증과 술 중 혈압 변화에 미치는 영향", Korean Journal of Anesthesiology, 43(5), pp.625~632 (2002), 대한마취통증의학회
- McLaughlin JG, "The adverse hemodynamic effects of laparoscopic cholecystectomy", Surg Endosc, 9, pp.121~124 (1995)
- Joris JL, "Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine", J Am Coll Cardiol, 32, pp.1389~1396 (1998)
- Jee D, "Magnesium sulphate attenuates arterial pressure increase during laparoscopic cholecystectomy", Br J Anaesth, 103, pp.484~489 (2009)
- Hein HA, "Hemodynamic changes during laparoscopic cholecystectomy in patients with severe cardiac disease", J Clin Anesth, 9, pp.261~265 (1997)
- Portera CA, "Benefits of pulmonary artery catheter and transesophageal echocardiographic monitoring in laparoscopic cholecystectomy patients with cardiac disease", Am J Surg, 169, pp.202~206 (1995)
- Gupta K, "Premedication with clonidine versus fentanyl for intraoperative hemodynamic stability and recovery outcome during laparoscopic cholecystectomy under general anesthesia", Anesth Essays Res, 7, pp.29~33 (2013)
- Laisalmi M, "Clonidine provides opioid-sparing effect, stable hemodynamics, and renal integrity during laparoscopic cholecystectomy", Surg Endosc, 15, pp.1331~1335 (2001)
- Koivusalo AM, "Effects of esmolol on haemodynamic response to CO2 pneumoperitoneum for laparoscopic surgery", Acta Anaesthesiol Scand, 42, pp.510~517 (1998)
- Srivastava VK, "Comparative evaluation of dexmedetomidine and esmolol on hemodynamic responses during laparoscopic cholecystectomy", J Clin Diagn Res, 9, pp.UC01~UC5 (2015)
- Joris J, "Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine", Anesth Analg, 81, pp.379~384 (1995)
- Cunniffe MG, "A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy", Am J Surg, 176, pp.258~261 (1998)
- Elhakim M, "Intraperitoneal lidocaine for postoperative pain after laparoscopy", Acta Anaesthesiol Scand, 44, pp.280~284 (2000)
- Rademaker BM, "Intraperitoneal local anaesthetics after laparoscopic cholecystectomy:effects on postoperative pain, metabolic responses and lung function", Br J Anaesth, 72, pp.263~266 (1994)
- Szem JW, "A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy", Surg Endosc, 10, pp.44~48 (1996)
- Pasqualucci A, "Preemptive analgesia: intraperitoneal local anesthetic in laparoscopic cholecystectomy. A randomized, double-blind, placebo-controlled study", Anesthesiology, 85, pp.11~20 (1996)
- Mraović B, "Intraperitoneal bupivacaine for analgesia after laparoscopic cholecystectomy", Acta Anaesthesiol Scand, 41, pp.193~196 (1997)
- 강화자, "복강경 담낭절제술 후 복강 내 투여한 Lido-caine이 복통과 어깨 통증에 미치는 영향", Korean Journal of Anesthesiology, 42(2), pp.198~204 (2002), 대한마취통증의학회
- Shukla U, "Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post-operative analgesia following laparoscopic cholecystectomy: A comparative evaluation", Indian J Anaesth, 59, pp.234~239 (2015)
- Odeberg S, "Lack of neurohumoral response to pneumoperitoneum for laparoscopic cholecystectomy", Surg Endosc, 12, pp.1217~1223 (1998)
- Pınar HU, "The effect of pneumoperitoneum on the cross-sectional areas of internal jugular vein and subclavian vein in laparoscopic cholecystectomy operation", BMC Anesthesiol, 16, pp.62~ (2016)
- Hall JE, "Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions", Anesth Analg, 90, pp.699~705 (2000)
- Covino BG, "Neural blockade in clinical anesthesia and management of pain", pp.108~113 (1998), Lippincott-Raven
- Lynch C 3rd, "Depression of myocardial contractility in vitro by bupivacaine, etidocaine, and lidocaine", Anesth Analg, 65, pp.551~559 (1986)