Effects of pericardial administration of lidocaineon hemodynamic responses.

心包给药利多卡因对血流动力学反应的影响。

基本信息

批准号：
14571426
负责人：
AKAMATSU Shigeru
金额：
$ 1.34万
依托单位：
Gifu University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2002
资助国家：
日本
起止时间：
2002 至 2003
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-14571426/
关键词：
Local anesthetics Cardiac function CABG Cardiac tamponade Anesthesia Arrhythmia

项目摘要

Background : Tachycardiac responses during anesthesia should be better to avoid in the patients who have ischemic heart disease, especially during off-pump coronary artery bypass grafting surgery that needs the control of heart rate. Decrease of heart rate without change of cardiac contractility is ideal control of heart rate. In order to achieve this purpose, we tried to block the cardiac nerve with injection of local anesthetics given into the pericardial space. Methods : To examine whether a local anesthetic infusion into the pericardial space affects hemodynamics and arrhythmogenicity, we studied anesthetized, mechanical ventilated dogs having pulmonary catheter in place. We perfused the pericardial space with 2.5 or 5ml of 1% lidocaine, 5mi of 2% lidocaine, or normal saline solution for each 10 dogs. In the presence of pericardial lidocaine (1%), we observed the cardiac responses to intravenous atropine or isoproterenol. Further, to examine the inhibitory action to arrhythmia of p … More ericardial lidocaine, an electrical fibrillator was installed to decide the voltage of inducing arrhythmia or ventricular fibrillation. Also six dogs were used for measurement of serum concentration of lidocaine. Results : The pericardial administration of lidocaine soon decreased heart rate (HR) (about 80% from control within 5min, p<0.05), dose-dependently and significantly without changes in stroke volume (SV). In the presence of pericardial lidocaine, HR responses to isoproterenol were significant, but similar to that without pericardial lidocaine. However, HR response to atropine was completely blocked with pericardial lidocaine. Changes of plasma lidocaine concentration were completely different between intravenous injection and pericardial infusion. Intravenous injection of lidocaine elevated plasma concentration of lidocaine immediately, whereas the pericardial infusion of lidocaine elevated it 10min after its administration. The pericardial lidocaine rose the threshold for arrhythmia and ventricular fibrillation (from 1.6V to 2.2V, p<0.01). Conclusions : Pericardial administration of lidocaine well controlled HR, and could preserve HR responses to isoproterenol, but completely blocked HR responses to atropine. And it inhibited arrhythmia and ventricular fibrillation induced by electrical fibrillator. These results suggest that pericardial lidocaine may be suitable for control of HR during off-pump coronary artery bypass grafting surgery. Less

背景：缺血性心脏病患者应避免麻醉过程中出现心动过速反应，特别是在需要控制心率的非体外循环冠状动脉搭桥手术中，理想的控制是降低心率而不改变心肌收缩力。为了达到这一目的，我们尝试通过向心包腔注射局麻药来阻断心脏神经。方法：检查向心包腔内注入局麻药是否会产生影响。为了研究血流动力学和心律失常性，我们研究了装有肺导管的麻醉机械通气狗，每 10 只狗在心包腔内灌注 2.5 或 5 毫升 1% 利多卡因、5 毫升 2% 利多卡因或生理盐水。心包利多卡因（1%），我们观察了静脉注射阿托品或异丙肾上腺素的心脏反应。此外，为了检查心包利多卡因对心律失常的抑制作用，安装了电颤器来确定诱发心律失常或心室颤动的电压，还使用六只狗来测量利多卡因的血清浓度。利多卡因很快就降低了心率 (HR)（5 分钟内比对照降低约 80%，p<0.05），呈剂量依赖性且显着在存在心包利多卡因的情况下，对异丙肾上腺素的 HR 反应显着，但与没有心包利多卡因的 HR 反应相似。然而，心包利多卡因的 HR 反应被完全阻断。静脉注射和心包输注完全不同，静脉注射利多卡因立即升高利多卡因的血浆浓度，而心包输注则明显不同。利多卡因给药 10 分钟后，心包利多卡因升高了心律失常和心室颤动的阈值（从 1.6V 至 2.2V，p<0.01）。但完全阻断了阿托品的 HR 反应，并且抑制了心律失常和心室颤动。这些结果表明，心包利多卡因可能适用于非体外循环冠状动脉搭桥手术期间的心率控制。