We investigated the effect of IV lidocaine on the hemodynamic and bispectral index responses to induction of general anesthesia and endotracheal intubation. Forty patients (ASA I) were randomly allocated into 2 groups of 20 to receive normal saline or lidocaine 1.5 mg/kg IV 30 s after induction. Ninety seconds later, endotracheal intubation was performed. Systolic blood pressure, heart rate, and bispectral index were measured at baseline, 1 min after induction, at preintubation, and every minute until 5 min after endotracheal intubation. Bispectral index at 1 min after induction and preintubation in the lidocaine group were significantly lower compared with the control group (P < 0.05). Systolic blood pressure increased significantly at 1 and 2 min after intubation in the control group compared with the baseline value (P < 0.05) but did not increase significantly in the lidocaine group. Heart rate increased at 1 to 3 min in both groups (P < 0.05), but there was no significant difference between the two groups. One patient in the control group had recall of the procedure. We conclude that the administration of IV lidocaine (1.5 mg/kg) does not suppress the hypnotic response to endotracheal intubation.

We experienced a case of malignant hyperthermia (MH) in 6-year-old boy during anesthesia induction for strabismus surgery. It has been generally reported that sevoflurane can induce the delayed onset of MH in the absence of succinylcholine. Our case of MH was elicited after about 2-3 min of sevoflurane administration with N2O, O2 and rocuronium. However, we successfully treated the patient by early recognition of his condition and administering symptomatic treatment and dantrolene.

The effects of midazolam used with low concentration inhaled anaesthetics on the bispectral index (BIS) was investigated after fetal expulsion during caesarean section. Forty-five patients undergoing caesarean section received either normal saline (control, n = 15), or an intravenous bolus of 0.03 mg/kg (n = 15) or 0.05 mg/kg (n = 15) midazolam. Changes in BIS and maternal haemodynamics were monitored before induction, on intubation, at uterine incision, on delivery, at 3, 5 and 10 min after fetal expulsion, at subcutaneous tissue closure, at skin closure, on eye opening and at extubation. BIS values in the group that received 0.05 mg/kg midazolam were significantly lower than in the other two groups at 3, 5 and 10 min after fetal expulsion, and at subcutaneous tissue closure and skin closure. Values of BIS < 60 could only be maintained with 0.05 mg/kg midazolam and there was no delay in maternal emergence or recovery.