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KMID : 0350519930460030967
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Journal of Catholic Medical College
1993 Volume.46 No. 3 p.967 ~ p.975
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The Effect of Lidocaine HCI Aaministered into Epidural Space on the Neuromuscular Blocking Action of Vecuronium
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Abstract
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Intravenous local anesthetics inhibit neuromuscular transmission and enhance the neuromuscular block of both nondepolarizing and depolarizing mucle relaxants. Local anesthetics used to treat cardiac arrhythmias perioperatively may greatly augment
a
residual neuromuscular block. To obtain sdequate balanced anesthesia and postoperative analgesia, general anesthesia with epidural anesthesia is frequently selected.
In the present study we investigated the effects of lidocaine HCl administered into epidural space on the neuromuscular blocking action of vecuronium.
Eighty adult gynecoiogical patients of ASA classⅠorⅡwere studied.
Patients were divided into four groups as follows ;
GroupⅠ (n=20) ; vecuronium 0.1 mg/kg iv administered only
GroupⅡ (n=20) ; vecuronium 0.1 mg/kg iv and lidocaine 6 mg/kg administered into epidural space
GroupⅢ (n=20) ; vecuronium 0.1 mg/kg iv and lidocaine 8 mg/kg administered into epidural space
GroupⅣ (n=20) ; vecuronium 0.1 mg/kg iv and lidocaine 10 mg/kg administered into epidural space
Patients of experimental groupsⅡ, Ⅲ and Ⅳ were anesthetized by epidural block with 2% lidocaine followed by general anesthesia 15 minutes later.
Before induction with fentanyl(3㎍/kg), drop[eridol(0.04 mg/kg), 2.5% thiopental scdium (5 mg/kg) and vecuronium(0.1 mg/kg) iv, neuromuscular monitoring was set by using ABM(Anesthesia and Brain activity Monitor, Datex Co., Finland) which
stimulating
ulnar nerve at the wrist with supramaximal stimuli at a frequency of 2 Hz and 20 seconds interval. The electromyographic response of the hypothenar muscles was recorded. Following stabilization of the control twitch height, vecuronium(0.1 mg/kg)
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intravenously administered and tracheal intubation was performed when the first twitch height of the train of four twitch responses(T1) was 5% of the control. Anesthesia was maintained with O2 ( L/mln) and N2O (4 L/min).
The time of onset of action (time from vecuronium iv to 0% of T1), time of maximal twitch depression (time from loss of T1 to reappearance of T1), recovery index (time from recovery of 25% of T1 to 75% of T1) and T4 ratios (ratio of the height of
the
fourth twitch to T1) at 25%, 50% and 75% of T1 were measured and compared among the groups.
@ES The results were as follows ;
@EN 1. The time of onset of action was 3.99±0.92 minutes in the control group and 2.94±0.89 miniutes in the lidocaine 10 mg/kg administered group(P<0.05).
2. The time maximal twitch depression was 19.05±5.46 minutes in the control group and 24.02±6.94, 25.33±5.84, 27.07±5.26 minutes in the lidocaine 6 mg/kg, 8mg/kg, 10 mg/kg administered agroups respectively(P<0.05).
3. Recovery index was 14.75±5.40 minutes in the control group and 20.39±4.56, 22.36±7.98 minutes in the lidocaine 8 mg/kg, 10 mg/kg administered grops respectively (P<0.05).
4. The lidocaine administered into epidural space has little effect on the recovery of T4 compared with that of T1(P>0.05).
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