Atteenuation of cardiovascular response to emergence from anaesthesa and tracheal extubation by either topical lidocaine, intravenous lidocaine or verapamil

ABSTRACT

We have examined the effect of either topical lidocaine, intravenous lidocaine or intravenous verapamil on the haemodynamic response to emergence from anaesthesia and endotracheal extubation in 80 adult ASA I or II patients, undergoing a variety of elective surgical procedures. All patients received a standard general anaesthetic. At the end of surgery group A [control group n = 20], received a bolus dose of 10ml normal saline 2 minutes before extubation. Group B [topical lidocaine n = 20], had their larynx and vocal cords sprayed with 10% aerosolized lidocaine [40mg] after induction and 2 minutes before intubation plus 10ml normal saline, 2 minutes before extubation. Group C [IV lidocaine n = 20], received a bolus dose of 1 mg kg-1 lidocaine diluted up to 10mI in normal saline, 2 minutes before extubation. Group D [IV verapamil] received a bolus dose of 0.1mg kg-1 verapamil diluted up to 10ml in normal saline, 2 minutes before extubation. Arterial pressure, heart rate, ECG, peripheral oxygen saturation and end tidal CO2 were recorded at pre induction, end of surgery, 2 minutes before extubation and at 1 and 5 minutes after extubation. The quality of extubation was evaluated using an extubation score. It was found that topical lidocaine, IV lidocaine and verapamil have attenuated the increase in both heart rate and arterial blood pressure following extubation compared with pre induction values and significantly attenuated the cardiovascular response as compared to the control group [p<0.001]. Tracheal scoring however showed that topical lidocaine had the lowest favourable sore [p<0.001] followed by IV lidocaine [p<0.05], while IV verapamil showed no significant change when compared to the control group