Effects of Lidocaine Oropharyngeal Spray Applied Before Endotracheal Intubation on QT Dispersion in Patients Undergoing Coronary Artery Bypass Grafting: A Prospective Randomized Controlled Study

Murat Bilgi, Yusuf Velioglu, Hamit Yoldas, Mehmet Cosgun, Ahmet Yuksel, Ibrahim Karagoz, Isa Yildiz, Abdulhamit Es, Duygu Caliskan, Kemalettin Erdem, Abdullah Demirhan, Murat Bilgi, Yusuf Velioglu, Hamit Yoldas, Mehmet Cosgun, Ahmet Yuksel, Ibrahim Karagoz, Isa Yildiz, Abdulhamit Es, Duygu Caliskan, Kemalettin Erdem, Abdullah Demirhan

Abstract

Objective: To investigate the effects of lidocaine oropharyngeal spray applied before endotracheal intubation on hemodynamic responses and electrocardiographic parameters in patients undergoing coronary artery bypass grafting.

Methods: A total of 60 patients who underwent coronary artery bypass grafting surgery were included in this prospective randomized controlled study. Patients were randomly divided into two groups, the topical lidocaine group (administration of 10% lidocaine oropharyngeal spray, five minutes before laryngoscopy and endotracheal intubation) and the control group. Both groups were compared with each other in terms of main hemodynamic parameters including mean arterial pressure and heart rate, as well as P and QT wave dispersion durations, before and after endotracheal intubation.

Results: The groups were similar in terms of age, gender, and other demographics and basic clinical characteristics. There was a statistically significant difference between the groups in terms of QT dispersion durations after laryngoscopy and endotracheal intubation. The increase in QT dispersion duration was not statistically significant in the topical lidocaine group, whereas the increase in QT dispersion duration was statistically significant in the control group. When the groups were compared in terms of P wave dispersion durations, there were significant decreases in both groups, but there was no significant difference between the groups.

Conclusion: Our study revealed that the topical lidocaine administration before endotracheal intubation prevented increase of QT dispersion duration in patients undergoing coronary artery bypass grafting.

Trial registration: NCT03304431.

Keywords: CABG; Coronary Artery Bypass Grafts; Hemodynamic Response; QT Dispersion; Topical Lidocaine.

Conflict of interest statement

No conflict of interest.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram. CONSORT=Consolidated Standards of Reporting Trials; ECG=electrocardiography
Fig. 2
Fig. 2
Comparison of mean arterial pressure between control group and lidocaine group.
Fig. 3
Fig. 3
Comparison of heart rate between control group and lidocaine group.

References

    1. Reusser A, Blum S, Aeschbacher S, Eggimann L, Ammann P, Erne P, et al. QTc interval, cardiovascular events and mortality in patients with atrial fibrillation. Int J Cardiol. 2018;252:101–105. doi: 10.1016/j.ijcard.2017.11.078.
    1. Pirlich N, Lohse JA, Schmidtmann I, Didion N, Piepho T, Noppens RR. A comparison of the Enk fiberoptic atomizer setTM with boluses of topical anaesthesia for awake fibreoptic intubation. Anaesthesia. 2016;71(7):814–822. doi: 10.1111/anae.13496.
    1. Mohanan Nair KK, Namboodiri N, Kevadiya H, Valaparambil A. Abolition of T-wave alternans in a case of congenital long-QT syndrome with atrial pacing. J Cardiovasc Electrophysiol. 2018;29(12):1718–1720. doi: 10.1111/jce.13710.
    1. Trinkley KE, Page RL 2nd, Lien H, Yamanouye K, Tisdale JE. QT interval prolongation and the risk of torsades de pointes: essentials for clinicians. Curr Med Res Opin. 2013;29(12):1719–1726. doi: 10.1185/03007995.2013.840568.
    1. Owczuk R, Wujtewicz MA, Sawicka W, Piankowski A, Polak-Krzeminska A, et al. The effect of intravenous lidocaine on QT changes during tracheal intubation. Anaesthesia. 2008;63(9):924–931. doi: 10.1111/j.1365-2044.2008.05525.x.
    1. Kahl M, Eberhart LH, Behnke H, Sänger S, Schwarz U, Vogt S, et al. Stress response to tracheal intubation in patients undergoing coronary artery surgery: direct laryngoscopy versus an intubating laryngeal mask airway. J Cardiothorac Vasc Anesth. 2004;18(3):275–280. doi: 10.1053/j.jvca.2004.03.005.
    1. Yüksel A, Kan II, Yolgösteren A, Velioglu Y, Çayir MÇ, Gürbüz O, et al. Are the early postoperative outcomes of coronary artery bypass grafting surgery in elderly women worse compared to men's. Braz J Cardiovasc Surg. 2017;32(3):191–196. doi: 10.21470/1678-9741-2016-0071.
    1. Feng CK, Chan KH, Liu KN, Or CH, Lee TY. A comparison of lidocaine, fentanyl, and esmolol for attenuation of cardiovascular response to laryngoscopy and tracheal intubation. Acta Anaesthesiol Sin. 1996;34(2):61–67. Erratum in Acta Anaesthesiol Sin. 1996;34(3):172.
    1. Daabiss M, Hashish M. Effects of lornoxicam on the hemodynamic and catecholamine response to laryngoscopy and tracheal intubation. Eur J Clin Pharmacol. 2011;67(8):783–786. doi: 10.1007/s00228-011-1017-4.
    1. Zhang N, Gong M, Tse G, Zhang Z, Meng L, Yan BP, et al. Prolonged corrected QT interval in predicting atrial fibrillation: a systematic review and meta-analysis. Pacing Clin Electrophysiol. 2018;41(3):321–327. doi: 10.1111/pace.13292.
    1. Okin PM, Devereux RB, Howard BV, Fabsitz RR, Lee ET, Welty TK. Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American indians: the strong heart study. Circulation. 2000;101(1):61–66. doi: 10.1161/01.cir.101.1.61.
    1. Gholipour Baradari A, Habibi MR, Habibi V, Nouraei SM. Administration of lidocaine to prevent cognitive deficit in patients undergoing coronary artery bypass grafting and valve plasty: a systematic review and meta-analysis. Expert Rev Clin Pharmacol. 2017;10(2):179–185. doi: 10.1080/17512433.2017.1266252.
    1. Cheng MH, Yao YM. Effects of esmolol and fentanyl on the hemodynamic and catecholamine response to tracheal intubation in hypertensive patients. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2003;15(7):435–437. Chinese.
    1. Singh S, Laing EF, Owiredu WK, Singh A. Comparison of esmolol and lidocaine for attenuation of cardiovascular stress response to laryngoscopy and endotracheal intubation in a Ghanaian population. Anesth Essays Res. 2013;7(1):83–88. doi: 10.4103/0259-1162.114008.
    1. Lev R, Rosen P. Prophylactic lidocaine use preintubation: a review. J Emerg Med. 1994;12(4):499–506. doi: 10.1016/0736-4679(94)90347-6.
    1. Barak M, Ziser A, Greenberg A, Lischinsky S, Rosenberg B. Hemodynamic and catecholamine response to tracheal intubation: direct laryngoscopy compared with fiberoptic intubation. J Clin Anesth. 2003;15(2):132–136. doi: 10.1016/S0952-8180(02)00514-7.
    1. Kaneko M, Yamaguchi S, Hamaguchi S, Egawa H, Fujii K, Ishikawa K, et al. Effects of landiolol on QT interval and QT dispersion during induction of anesthesia using computerized measurement. J Clin Anesth. 2009;21(8):555–561. doi: 10.1016/j.jclinane.2008.12.027.
    1. Fishman SL, Sonmez H, Basman C, Singh V, Poretsky L. The role of advanced glycation end-products in the development of coronary artery disease in patients with and without diabetes mellitus: a review. Mol Med. 2018;24(1):59–59. doi: 10.1186/s10020-018-0060-3.
    1. Yuksel A, Yolgosteren A, Kan II, Cayir MC, Velioglu Y, Yalcin M, et al. A comparison of early clinical outcomes of off-pump and on-pump coronary artery bypass grafting surgery in elderly patients. Acta Chir Belg. 2018;118(2):99–104. doi: 10.1080/00015458.2017.1383087.
    1. Wendelin-Saarenhovi M, Isoaho R, Hartiala J, Kivelä SL, Helenius H, Irjala K, et al. Ambulatory blood pressure: associations with coronary heart disease in the aged Finnish population. Aging Clin Exp Res. 2007;19(6):432–437. doi: 10.1007/BF03324727.
    1. Prys-Roberts C, Greene LT, Meloche R, Foex P. Studies of anaesthesia in relation to hypertension. II: Hemodynamic consequences of induction and endotracheal intubation. 1971. Br J Anaesth. 1998;80(1):106–122. doi: 10.1093/bja/80.1.106.
    1. Estafanous FG, Tarazi RC. Systemic arterial hypertension associated with cardiac surgery. Am J Cardiol. 1980;46(4):685–694. doi: 10.1016/0002-9149(80)90521-4.
    1. Talwar V, Ganeriwal V, Aggarwal S, Gupta A. Efficacy of combination of esmolol and diltiazem for attenuating hemodynamic response to laryngoscopy and intubation: a prospective randomized study. Anesth Essays Res. 2018;12(3):674–679. doi: 10.4103/aer.AER_76_18.
    1. Modir H, Yazdi B, Moshiri E, Mohammadbeigi A, Afshari S. Efficacy of dexmedetomidine versus remifentanil to blunt the hemodynamic response to laryngoscopy and orotracheal intubation: a randomized clinical trial. Med Gas Res. 2018;8(3):85–90. doi: 10.4103/2045-9912.241065.
    1. Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth. 1987;59(3):295–299. doi: 10.1093/bja/59.3.295.
    1. Lee DH, Park SJ. Effects of 10% lidocaine spray on arterial pressure increase due to suspension laryngoscopy and cough during extubation. Korean J Anesthesiol. 2011;60(6):422–427. doi: 10.4097/kjae.2011.60.6.422.
    1. Bourolias C, Gkotsis A, Kontaxakis A, Tsoukarelis P. Lidocaine spray vs tetracaine solution for transnasal fiber-optic laryngoscopy. Am J Otolaryngol. 2010;31(2):114–116. doi: 10.1016/j.amjoto.2008.11.011.
    1. Mostafa SM, Murthy BV, Barrett PJ, McHugh P. Comparison of the effects of topical lignocaine spray applied before or after induction of anaesthesia on the pressor response to direct laryngoscopy and intubation. Eur J Anaesthesiol. 1999;16(1):7–10. doi: 10.1097/00003643-199901000-00003.
    1. Shah K. ProSeal laryngeal mask airway as an alternative to standard endotracheal tube in securing upper airway in the patients undergoing beating-heart coronary artery bypass grafting. Ann Card Anaesth. 2017;20(1):61–66. doi: 10.4103/0971-9784.197838.
    1. Dekker JM, Schouten EG, Klootwijk P, Pool J, Kromhout D. Association between QT interval and coronary heart disease in middle-aged and elderly men. The Zutphen study. Circulation. 1994;90(2):779–785. doi: 10.1161/01.cir.90.2.779.
    1. Booker PD, Whyte SD, Ladusans EJ. Long QT syndrome and anaesthesia. Br J Anaesth. 2003;90(3):349–366. doi: 10.1093/bja/aeg061.
    1. Cafiero T, Di Minno RM, Di Iorio C. QT interval and QT dispersion during the induction of anesthesia and tracheal intubation: a comparison of remifentanil and fentanyl. Minerva Anestesiol. 2011;77(2):160–165.
    1. Hanci V, Yurtlu S, Karabag T, Okyay D, Hakimoglu S, Kayhan G, et al. Effects of esmolol, lidocaine and fentanyl on P wave dispersion, QT, QTc intervals and hemodynamic responses to endotracheal intubation during propofol induction: a comparative study. Braz J Anesthesiol. 2013;63(3):235–244. doi: 10.1016/S0034-7094(13)70223-X.
    1. Jolliffe CT, Leece EA, Adams V, Marlin DJ. Effect of intravenous lidocaine on heart rate, systolic arterial blood pressure and cough responses to endotracheal intubation in propofol-anaesthetized dogs. Vet Anaesth Analg. 2007;34(5):322–330. doi: 10.1111/j.1467-2995.2006.00330.x.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi