Hye Ja Lim

Lidocaine does not prevent bispectral index increases in response to endotracheal intubation

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.

Association Between Tumor Necrosis Factor α 308G/A Polymorphism and Increased Proinflammatory Cytokine Release After Cardiac Surgery With Cardiopulmonary Bypass in the Korean Population

OBJECTIVES The G-308A polymorphism of the tumor necrosis factor alpha (TNF-alpha) gene has been suggested to be linked to high TNF promoter activity in in vitro studies. However, there have been some controversies in in vivo studies. This study investigated whether A allele at TNF-308 site is associated with (1) the changes in plasma cytokine levels during and after cardiopulmonary bypass (CPB) and (2) an increased incidence of pulmonary morbidity after CPB. DESIGN Prospective and observational investigation. SETTING A university hospital, single institution. PARTICIPANTS Patients scheduled for cardiac surgery with CPB. INTERVENTION TNF genotype was determined by the real-time polymerase chain reaction method. IL-6 and TNF-alpha levels were measured by enzyme-linked immunosorbent assay at the following time points: T1, before initiation of CPB; T2, 30 minutes of CPB; T3, 30 minutes after CPB; T4, 2 hours after CPB; and T5, 24 hours after CPB. The oxygen index, serum creatinine level, 24-hour blood loss, intubation time, and length of intensive care unit (ICU) stay were examined. MEASUREMENTS AND MAIN RESULTS The levels of TNF-alpha in group A (TNF-308GA/AA, n = 25) were higher at T3, T4, and T5 than group G (TNF-308GG, n = 225). The levels of IL-6 showed no statistical difference. The oxygenation index, serum creatinine level, 24-hour blood loss, intubation time, and length of ICU stay showed no statistical difference. CONCLUSIONS TNF G-308A polymorphism may be associated with excess TNF-alpha secretion in this study and may not be associated with excess IL-6 secretion and postoperative morbidity after CPB.

Optimal anesthetic regimen for ambulatory laser microlaryngeal surgery

Laser microlaryngeal surgery (LMS) is a short operation requiring brief and intense paralysis. Adequate muscle relaxation and rapid recovery of neuromuscular function are essential for improving surgical conditions and reducing the incidence of complications during LMS. However, the ideal muscle relaxant with a rapid onset and short duration of action is not yet available. Rocuronium has rapid onset at higher doses, but with a prolonged duration of action. Sugammadex is a selective relaxant‐binding agent that allows for rapid reversal of rocuronium‐induced neuromuscular blockade. This study aimed to compare the surgical conditions and anesthesia time between two combinations of neuromuscular blocker and reversal agent, rocuronium‐sugammadex (R‐S) and succinylcholine‐cisatracurium‐pyridostigmine (S‐C‐P), and propose an optimal anesthetic regimen for improving the surgical conditions in LMS patients.