The Effects Of Intravenous Administration Of Lidocaine On Cisatracurium-induced Neuromuscular Block During Remifentanil Based-anesthesia

Objective:The purpose of this study was to investigate the effect of pre-treatment with lidocaine on the onset and recovery-time course of cisatracurium-induced neuromuscular block during remifentanil based-anesthesia. Method:80adults ASA grade Ⅰ～Ⅱ patients undergoing laparoscopic cholecystectomy were enrolled. The patients were randomly allocated to four groups (GroupL, R,LR, C). Group L and Group LR received a dose of1.5mg/kg lidocaine prior to anesthesia induction. Group C and Group R received a dose of0.075ml/kg saline prior to anesthesia induction. Anaesthesia was induced and maintained with a target-controlled infusion (TCI) of propofol (plasma concentration,Cp;4μg/ml) and remifentanil(plasma concentration,Cp;4.5ng/ml) or intravenous injection of fentanyl(3μg/kg). After loss of consciousness, cisatracurium0.15mg/kg was given. Neuromuscular blockade was evaluated with accelerometry, which measured a train-of-four (TOF) pattern of abductor policies muscle. The disappearance of the fourth and first response in TOF was regarded as intubating time and onset of neuromuscular block. The time from the end of injecting cisatracurium to the TOF ratio5%,25%,75%were recorded.Changes in systolic and diastolic arterial pressure (SBP, DBP) and heart rate (HR) were measured before, on and after tracheal intubation. The intubation conditions were evaluated by W.Puchner method. Results:Intubating time (T4) was on average111.3s (standard deviation16.8) in Group L,93.7s (21.6) in Group LR with lidocaine and179.6(21.8) in Group C,170.8(22.7) in Group R with saline (p<0.05); Onset time (T1) was on average127.8s (12.0) in Group L,117.8s (22.0) in Group LR with lidocaine and214.8(34.6) in Group C,200.2(22.7) in Group R with saline (p<0.05); There were not significant difference on effective clinical duration (until TOF ratio has recovered to5%),clinical duration (until TOF ratio has recovered to25%)and recovery time(until TOF ratio has recovered to75%)in all groups (p>0.05);The intubation scores were not significant in all groups(p>0.05); At the time point of intubation, SBP and HR in Group C and Group L increased compared with Group R and Group LR, the changes were significant (p<0.05). No single case of awareness during the surgery happened in PACU investigation. Conclusion:Intravenous lidocaine pretreatment accelerates the onset time of cisatracurium induced neuromuscular block, but has no impact on the recovery time-course. Targed-controlled Infusions of remifentanil has no impact on the onset time and recovery time-course of cisatracurium induced-neuromuscular block. Targed-controlled Infusions of remifentanil combined with lidocaine accelerates the onset time of cisatracurium but has no compact on the recovery time-course.