Comparison of hemodynamic response for intubation and propofol pain caused by lidocaine administration with infusion and tourniquet

Abstract

Propofol is one of the most widely used i.v. anesthetic agent. Nevertheless, pain following i.v. administration of propofol is an important problem in anesthesia induction. A wide range of studies have been performed related to lidocaine effects on propofol injection pain and hemodynamic response to intubation. However, effect of both situations are seldomly studied in the literature. In our study we compare lidocaine effects on propofol injection pain and hemodynamic response to intubation which is given by infusion or under tourniquet as i.v. bolus. 70 patients attended to the study are separated randomly into two groups of 35 patients. Prior to induction, lidocaine has been infused with infusion pump as to be completed in 2 minutes with concentration of 2%, total dosed 1mg/kg in infusion group (Group I, n=35). In this group, after half of the total lidocaine dose is infused (1st minute), anesthesia induction has been started by giving 40 mg propofol of 1% in 10 seconds with infusion pump. In tourniquet group (Group T, n=35) prior to induction 1mg/kg lidocaine has been given as bolus by applying tourniquet with 70 mm/Hg pressure to the arm that is established vascular access and tourniquet has been remained for 60 seconds. After opening the tourniquet, induction has been started by giving 40 mg propofol of 1% in 10 seconds with infusion pump. During induction, patient"s consciousness was evaluated by questioning his/her name and age after administering 1/4 (VRS0), 1/2 (VRS1), and 3/4 (VRS2) of total propofol dose. Confused patients were eliminated and the sense of pain caused by propofol was evaluated in study patients. The results were recorded according to four-point categorical verbal rating scale (VRS). For groups, the pulse rates and mean arterial pressures before lidocaine administration (T0), after lidocaine (T1), immediately after intubation (T2) and 10th minute after intubation (T3) were recorded. No differences detected among the groups with regards to demographic data and side effects. (p>0.05). No significant differences statically detected when comparing the heart rate (HR), mean arterial pressure (MAP) and pain scores of groups for all times (p>0.05). It is concluded that administering lidocaine by infusion technic may be an alternative method for tourniquet method on suppressing hemodynamic response related to tracheal intubation and on preventing injection pain related to propofol.