ARTICLE INFO

Article Type

Original Research

Authors

Hamzei   A. (1 )
Basiri Mogadam   M. (2 )
Esmaeili   M. (* )
Delshad Noghabi   A. (2 )






(* ) “Student Research Committee” and “Nursing Department, Nursing & Midwifery Faculty”, Gonabad University of Medical Sciences, Gonabad, Iran
(1 ) Anesthesia & Operating Room Department, Paramedical Faculty, Gonabad University of Medical Sciences, Gonabad, Iran
(2 ) Nursing Department, Nursing & Midwifery Faculty, Gonabad University of Medical Science, Gonabad, Iran

Correspondence

Address: Deputy of Education & Research, Gonabad University of Medical Sciences, Near Asian Road, Gonabad, Iran
Phone: +985157225027
Fax: +985157220578

Article History

Received:  January  13, 2015
Accepted:  March 19, 2015
ePublished:  April 16, 2015

BRIEF TEXT


… [1-13] In comparison between laryngoscopy and intubation, the most hemodynamic changes occur due to the laryngoscopy [14, 15]. … [16] Intravenous injection of lidocaine 60-90 seconds before intubation is useful, but it may be associated with complications of the central nervous system and cardiovascular system. [17]. … [18-20]. Lidocaine spray easily penetrates into the mucosa [21, 22]. The utilization of spray on laryngoscope blade minimizes the complications of using spray in the mouth and the airway.

Non-declared

The aim of this study was to compare the effects of lidocaine spray 10% on the laryngoscope blade with intravenous lidocaine on the cardiovascular responses to laryngoscopy and intubation in the surgery selected patients.

This study is a clinical trial of the temporal series model with the control group.

Patients aged 15-65 years who were in class A of anesthesia (without specific systemic disease) based on physical examination and their cardiovascular situation and were scheduled for elective surgery in the hospitals in Gonabad (Iran) were studied in 2012.

90 patients were selected randomly.

Patients randomly divided into three groups: control, intravenous lidocaine and lidocaine spray 10% respectively. In all three groups, the same anesthetic dose was given. In intravenous group 1mg/kg of intravenous lidocaine was used 60-90 seconds before laryngoscopy and in the spray group, 1.5 mg/kg lidocaine spray 10% (Irandaroo Company; Tehran, Iran) was used three minutes after induction of anesthesia (immediately before laryngoscopy) on the laryngoscope blade. In the control group, no drug was used. Blood pressure and heart rate was measured immediately before laryngoscopy, immediately after laryngoscopy and on the first, third and fifth minutes after laryngoscopy. Data analysis was done using SPSS 20 software and Repeated Measures ANOVA test. At first, Kolmogorov-Smirnov test was used to determine data normality. To compare these variables (cardiovascular indicators) before the intervention, immediately after the intervention and first, third and fifth minutes after the intervention, Repeated Measure of Analysis of Variance (ANOVA) was used. To compare cardiovascular parameters among three groups, One-way ANOVA was used. Tukey Post-hoc test was used to compare between control, spray, and intravenous groups. To compare qualitative variables (gender, marital status, occupation, education, type of surgery and surgical history), Chi-square test was used.

28 persons (31.1%) were male and 62 persons (68.9%) were female. 52 (57.8%) had the history of surgery and 38 patients (42.2%) did not have the history of surgery. In terms of the type of surgery, 15 patients (16.7%) had urology surgery, 18 (20%) had gynecologic surgery, 56 patients (62.12%) had general surgery and one (1/1%) had orthopedic surgery. In terms of the qualitative data among subjects in the three groups, there was no statistically significant difference. According to Repeated Analysis of Variance, there was significant difference in mean of heart rate before, immediately after, and one, three and five minutes after the intervention. Repeated Measures ANOVA, showed no significant difference among the three groups (Table 1). Concerning the mean of systolic blood pressure, according to Repeated Measured ANOVA, there was no significant difference between the steps before, immediately after and one, three and five minutes after the intervention. Repeated Measured ANOVA showed a significant difference between three groups. Turkey Post-hoc test showed a significant difference between the control and spray groups but the difference between spray and intravenous groups was not significant (Table 1). In terms of the mean of diastolic blood pressure, Repeated Measured ANOVA showed a significant difference between three groups in the steps before, immediately after and one, three and five minutes after the intervention. Tukey Post-hoc test showed significant differences between control, intravenous and spray groups, but the difference was not significant between intravenous and spray groups (Table 1). Regarding the mean of arterial pressure, Repeated Measured ANOVA showed a significant difference between the steps before, immediately after, and one, three and five minutes after the intervention. Tukey Post-hoc test showed significant differences between control, intravenous and spray groups. Nevertheless, the difference was not significant between the two intravenous and spray groups (Table 1).

There was no statistically significant difference between three groups in terms of cardiovascular responses before the intervention and the groups were homogeneous in this regard. Heart rate increased immediately after intubation in all groups [21], which confirms the findings of the present study. … [23, 24] Immediately after laryngoscopy and intubation, rate of the systolic blood pressure began to increase in three groups. In both groups immediately after laryngoscopy, there has been an increase in systolic blood pressure [25], which is consistent with the current study. Immediately after intervention, diastolic blood pressure increased in all groups. Immediately after intubation, there has been an increase in diastolic blood pressure in three groups [9]. Immediately after intervention, there was maximum arterial pressure mean value in the control group and minimum in the spray group. Immediately after laryngoscopy, arterial blood pressure mean value in both groups has been increased and in the second group, which has been received the spray, the value was higher than the first group, which has not been received the spray [26]. These results are consistent with the current study. In the first minute after the intervention, systolic blood pressure reached its peak in the intravenous and spray groups, but it reached the peak in control group in the third minute. In the first minute, diastolic blood pressure decreased in spray and intravenous groups, but increased in control group. Regarding the mean of arterial pressure, a declining trend was seen a minute after the intervention compared to the first minute in spray and intravenous groups, while increase was seen in control group. In the first minute, an increase was observed in the heart rate, systolic blood pressure, diastolic and mean of arterial blood in the control and studied groups, but this increase was higher in control group and there was a significant difference between control and studied groups [9, 19, 27, 28] that are consistent with the results of the current study. Three minutes after the intervention, the heart rate began to decrease in the three groups. The highest drops were in spray group and the lowest drop was in control group. Heart rate decreased 3 minutes after laryngoscopy in control group, lidocaine group, and spray on the pharyngeal-laryngeal area group and lidocaine spray on the oral-pharyngeal region group comparing to the heart rate after laryngoscopy; and the maximum reduction has been observed in the oral-pharyngeal group[9]. These results are consistent with the results of the present study. In the third minute, the most reducing trend in diastolic blood pressure was seen in spray group, but in control group, there was 1% increase in the amount of diastolic blood pressure in the third minute compared to the proceeding minute. In the third minute after laryngoscopy, diastolic blood pressure has been increased in spray and saline groups, but there was a greater increase in saline group [29], which is consistent with the current study. In three minutes after the intervention, there were maximum and minimum changes in arterial blood pressure mean value compared to the first minute in control and spray groups, respectively. In the third minute, the mean of arterial pressure has been increased in control group and studied groups compared to the baseline. In control group, there was higher increase in diastolic blood pressure than studied groups and there has been a significant difference between three groups [27], which is consistent with the current study. In the fifth minute, there were the highest and the lowest drops compared to the third minute in spray and intravenous groups, respectively. In control group, heart rate has not yet returned to the baseline. 5 minutes after laryngoscopy, heart rate has been significantly lower in spray group compared to control group that received no lidocaine [30] which confirms the findings of the present study. The most drops in systolic blood pressure in the fifth minute were in spray group and the lowest was in intravenous group. The highest systolic blood pressure was in the control group and the lowest was in the spray group. 5 minutes after intervention, there was a significant difference in systolic blood pressure in three groups. In the fifth minute, systolic blood pressure was highest in control group, but there was no significant difference between the two groups [9] that does not comply with the current study. In the fifth minute, maximum diastolic blood pressure was in the spray group compared to the proceeding minute and the lowest amount was in the intravenous group, whereas there has been 1.8% increase in the changes in control group compared to the proceeding minute. There was a significant difference between spray and intravenous groups. The highest diastolic blood pressure has been in the fifth minute after intubation in control group [9], which is consistent with this study, but there has been no significant difference between two groups t [9], which does not conform to this study. Five minutes after the intervention, the maximum of the mean of arterial pressure was in the intravenous group and lowest was in the spray group. Also, there was 0.7% increase in control group. Only in spray group, the mean of arterial blood pressure had returned to the base level. In the fifth minute after the laryngoscopy, there has been an increase in the mean of arterial blood pressure in two groups; and there was lower increase in second group, which had received the spray than the first group which had not received the spray. The mean of arterial pressure in spray group had returned to the base level, while there has been no return to the baseline in control group [30]. The results of both studies were consistent with the current study.

Further studies should be done in patients with emergency surgery, different ages, and anesthesia class above the class A and with a larger population. Hemodynamic indices in patients with heart diseases and cephalic-vascular patients with intubation should be compared.

Limited sample collecting time and exclusive study on the patients aged 15-65years with anesthetic class A, who were undergoing elective surgery, were of the limitations for the present study.

Lidocaine spray 10% on the laryngoscope blade can effectively control the cardiovascular responses to laryngoscopy and intubation (systolic blood pressure, diastolic blood pressure and arterial mean pressure); and it is a good alternative at times when intravenous lidocaine is not available or contraindicated.

The staff of surgical sections in the hospitals "22nd of Bahman" and "15th of Khordad" is appreciated.

Non-declared

All stages were approved by Ethical Committee of Gonabad University of Medical Sciences.

Council of Graduate Studies and Research Council of Gonabad University of Medical Sciences approved the project.

TABLES and CHARTS

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CITIATION LINKS

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