Intravenous lignocaine prior to intubation effect on rhythm and changes in heart rate and rate pressure product - abstract

Tracheal intubation is frequently associated with occurrence of cardiac dysrhythmias and is almost always accompanied by increases in systolic and diastolic blood pressure. In some instances, these cardiovascular changes may lead to disastrous complications. A prospective study was undertaken to evaluate the efficacy of intravenous lignocaine prior to intubation in blunting the cardiovascular responses to intubation in a West Indian population. Seventy-five clinically fit patients (age range 20 -40 years, mean 27.5) were included. They were divided into 3 groups as follows: Group A: received 1 mg/kg lignocaine hydrochloride as I.V. bolus dose 1 min prior to induction of anaesthesia. Group B: - received 2mg/kg lignocaine, and Group C: - No ligocaine (control). Parameters recorded were heart rate (HR), cardiac rhythm (ECG), systolic and diastolic bloodpressure (BP), and (heart) Rate - (systolic) pressure product (RPP). These were measured at the following times: 1. Prior to induction of anaesthesia, 2. During laryngoscopy and intubation, 3: 1 min following intubation and 4: 5 mins following intubation. After the pre-induction parameters were recorded, lignocaine was given in 1 and 2 mg/kg doses in groups A & B patients. One minute following lignocaine, patients were anaesthetised using standard techique and the trachea was intubated. All parameters were again recorded, lignocaine was given in 1 and 2 mg/kg doses in groups A percent B patients. One minute following lignocaine, patients were anaesthetised using standard technique and the trachea was intubated. All parameters were again recorded at the stated times. Both the HRs and RPPs increased significantly in all the 3 groups following intubation. The increase in group B (2mg/kg) was significantly lower than in the control group. Group A patients (1mg/kg) did not show any consistent difference, statistically, compared to the control group. The incidence of dysrhythmias was 64 percent in the control group, 32 percent in group A patients (1mg/kg) and 12 percent in group B (2mg.kg). Seventy per cent of all dysrhythmias occurred at the time of laryngoscopy and intubation, consisting mainly of supra-ventricular and ventricular ectopics. Intravenous lignocaine prior to intubation decreases the incidence of dysrhythmias and also decreases the degree of rise in HRs and RPPs. Lignocaine at a dose of 2 mg/kg is better than a dose of 1 mg/kg (AU)

A prospective study of anaesthesia related morbidity and mortality - abstract

A 2-year (1981-82) prospective study was undertaken to determine the incidence of morbidity and mortality related to anaesthesia at the University Hospital of the West Indies. Data was obtained from all patients subjected to anaesthesia relating to their pre-operative, intra-operative and post-operative (recovery room or ICU) course and, in relevant instances, the convalescent ward. A total of 8,334 anaesthetics were administered and the ages of the patients ranged from 3 days to 96 years (mean 36 years). Three hundred and sixty patients (4.31 per cent) developed a complication as a result of anaesthesia and, of these, 12 patients (0.14 per cent of the total) died. Five patients died following post-operative cardio-respiratory arrest whereas 6 patients died of intra-operative arrhythmia and/or hypotension. One patient, a 1-year old child, died post-operatively of hypoxic brain damage. The incidence of various organ system involvement among non-fatal complications were as follows: respiratory (45 percent), cardiovascular (32 percent), musculo-skeletal (3 percent) central nervous (<1 percent). Respiratory complications included laryngospasm and/or bronchospasm (49 percent), post-operative respiratory obstruction (15 percent), post-operative respiratory insufficiency (19 percent), pulmonary oedema following aspiration (4 percent). Fifty-five patients needed post-operative mechanical ventilation in the ICU. Aspiration of stomach contents occurred in 6 instances and 5 of these patients involved anaesthesia for emergency caesarean section. All of these patients improved with supportive therapy (AU)

Central venous catheter tip position with peripheral vein insertion

A study of the success rate of central venous line placement in 100 catheter insertions is presented. The need for selection of peripheral superficial sites and for radiological confirmation of the position of the catheter tip is stressed. The overall success rate of correct placement in this series is 84 per cent. (AU)

Rate and rhythm changes in the heart during intubation of the trachea

A prospective study done on 45 Jamaican patients is presented. The effects of either using or avoiding atropine premedication, and the spraying of the larynx with 4 per cent lignocaine and/or intravenous propanolol prior to the induction agent, on the heart rate and rhythm are described. The findings demonstrate a significant increase in the heart rate during laryngoscopy and intubation in all groups of patients and neither lignocaine nor propanolol afford any appreciable protection against increase in heart rate. However, both these agents completely eliminate the incidence of the intubation arrhythmias (AU)