Effect of local administration of Lidocaine with epinephrine on ETCO2 and hemodynamics in pediatric patients undergoing cleft palate surgery

ABSTRACT

Supplementation of local epinephrine with anesthetic has a number of advantages. it prolongs the effect of anesthetics, reduces its amount required and speeds surgery by decreased bleeding into operative field. However, epinephrine has significant side effects. Increased end-tidal carbon dioxide concentration [ETCO2] has been reported if epinephrine at a concentration of 1 in 200,000 is injected into the nasal mucosa of patients undergoing general anesthesia for nasal surgery. Two concentrations of epinephrine were compared to determine the concentration effect on homodynamic and ETCO2 in pediatric patients undergoing cleft palate surgery Design: Prospective, randomized, single-blind clinical trial. Participants: Twenty four pediatric patients, aged 1 to 4 years undergoing cleft palate repair with general anesthesia were included in the study. To determine the epinephrine concentration effect on ETCO2 and hemodynamics in patients who received injections, in the hard palate, 3-3 ml mL of 1% lidocaine containing two concentrations of epinephrine [1200,000, or 1400,000] determined by randomization. Following local infiltration injection as mean values between 62 and 71 mmHg were maintained consistently throughout surgery. ETCO2 was transiently increased in both groups at 5 and 15 min after surgical incision, with significant difference between the two groups, P < 0.05 only at 15 min after incision. Surgeons did not complain about increase bleeding in the operative field in both groups. Amount of blood loss in group 1 is 71.25 +/- 15.49 ml compared with 72.25 +/- 13.53 ml in group II [P patients had an uncomplicated recovery and were well at postoperative follow-up. We observed transient increase ETCO2 and tachycardia after an injection of local anesthetic with epinephrine. A concentration with 2.5 ug/ml slightly raised ETCO2 with a statically insignificant effects on hemodynamics