Efficacy of oropharyngeal lidocaine instillation on hemodynamic responses to orotracheal intubation.

STUDY OBJECTIVE: To determine whether oropharyngeal instillation of lidocaine after anesthetic induction modifies the hemodynamic response to intubation. DESIGN: Prospective, randomized, double-blind, placebo-controlled study. SETTING: Operating room of a university hospital. PATIENTS: 56 ASA physical status I and II adult patients scheduled for elective surgery requiring orotracheal intubation and general anesthesia. INTERVENTIONS: Patients were randomized to receive oropharyngeal instillation with either 5 mL 2% lidocaine (n = 28, lidocaine group) or 5 mL normal saline (n = 28, control group) 45 seconds after anesthetic induction bolus. Orotracheal intubation was attempted three minutes later. MEASUREMENTS: Systolic (SBP), diastolic (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline, just before intubation, and for three minutes postintubation at one-minute intervals. Occurrence of adverse events such as arrhythmias, ischemic changes in electrocardiography, and bronchospasm after intubation were also documented. MAIN RESULTS: All postintubation values of SBP, DBP, MAP, and HR were significantly lower in the lidocaine group than the control group (P < 0.01). In both groups, postintubation HRs were significantly higher than baseline values (P < 0.05). More patients (P < 0.001) became hypertensive postintubation in the control group (14/28, 50%) than the lidocaine group (2/28, 7%). CONCLUSION: Oropharyngeal instillation of lidocaine for three minutes before intubation attenuates the cardiovascular responses to intubation.

Anesthesia for emergency cesarean section in a parturient with undiagnosed acute fatty liver of pregnancy--a case report.

Few clinical diagnoses of acute fatty liver of pregnancy (AFLP) are established immediately upon admission, while anesthetic interventions are frequently required on an emergent basis. We report a patient with the admitting diagnosis of severe preeclampsia with fetal distress necessitating an emergency cesarean section. An epidural block was instituted before laboratory data were available. Rapid changes of coagulation profiles occurred after delivery. The peripartum anesthetic care of the pregnant woman is presented. AFLP was confirmed by liver needle biopsy 26 days later. Taking our case as an examplification, clinicians must have a high suspicion that AFLP may exist in concurrence with preeclampsia when a parturient presents manifestations of nausea, jaundice, elevated bilirubin, elevated liver enzyme activities, prolonged PT and PTT, or thrombocytopenia.