Effects of lidocaine in combination with sevoflurane on myocardial protection in patients undergoing off-pump coronary artery bypass grafting / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the effects of lidocaine in combination with sevoflurane on myocardial protection in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods One hundred ASA physical status Ⅱ or Ⅲ and NYHA class Ⅰ or Ⅱ patients of both sexes,aged 45-70 yr,weighing 63-82 kg,scheduled for elective OPCABG,were randomly assigned into 4 groups (n=25 each)control group (group C),lidocaine group (group L),sevoflurane group (group S),sevoflurane combined with lidocaine group (group SL).Tracheal intubation was performed after induction of anesthesia.Anesthesia was maintained with iv infusion of propofol and intermittent iv boluses of sufentanil and pipecuronium.Bispectral index value was maintained at 45-55.Lidocaine 1.5 mg/kg was injected after intubation,followed by infusion at 2 mg/min until the end of surgery in L and SL groups.Sevoflurane was inhaled with end-tidal concentration of 2.2％-2.5％ starting from the end of intubation until the end of operation in S and SL groups.Before induction of anesthesia,at skin incision,immediately after transsection of internal mammary artery,after completion of anastomosis of the proximal aortovein and distal coronary artery,at the end of operation and at 24 h during operation,venous blood samples were obtained to detect the levels of plasma creatine kinase (CK),creatine kinase isoenzyme-MB (CK-MB) and cardiac troponin Ⅰ (cTnI).Lidocaine-related side effects such as arrhythmia,bradycardia or cardiac arrest were recorded during operation and within 24 h after operation.Results Compared with group C,the plasma CK,CK-MB and cTnI levels were decreased in the S,L and SL groups.The plasma CK-MB and cTnI levels were significantly lower in SL group than in L group.The plasma CK,CK-MB and cTnI levels were significantly lower in SL group than in S group.In L and SL groups,no patient developed lidocainerelated side effects.Conclusion Lidocaine 1.5 mg/kg injected intravenously after intubation,followed by infusion at 2 mg/min in combination with sevoflurane end-tidal concentration about 2.2％ ～2.5％ provides myocardial protection in patients undergoing OPCABG,the efficacy is stronger than that of either alone.