[Lidocaine plus fentanyl for controlling cardiovascular reactions to laryngoscopy and intubation]

Administration of fentanyl or lidocaine alone often insufficiently suppresses the haemodynamic reaction to laryngoscopy and intubation. We therefore evaluated the combination of both substances in patients with good ventricular performance (EF > 60%) undergoing coronary bypass surgery. 20 patients were randomly assigned to Group 1 (G1) or Group 2 (G2). As induction agents flunitrazepam (0.025 mg/kg), fentanyl (6-7 micrograms/kg) and pancuronium (0.1 mg/kg) were used. 3 minutes prior to intubation G1-patients received saline (0.1 cc/kg) while in G2 patients lidocaine (1 mg/kg) was administered. 10 minutes after termination of the preparations for induction (M1), prior to (M2), during (M3) and 10 minutes after the end of intubation (M4) heart rate (HR), blood pressure (MAP), pulmonary artery pressure (PAP) pulmonary capillary wedge pressure (PCWP) and cardiac output (CO) were measured. From these values we calculated rate-pressure product (RPP), total peripheral resistance (TPR), pulmonary vascular resistance (PVR), cardiac index (CI), stroke volume (SV) and stroke index (SI). Whitney-Mann test (U-test) served for statistical evaluation. If compared to baseline (M1), induction of anaesthesia caused in both groups a significant decrease of MAP (G1: 109 to 81 mmHg; G2: 97 to 77 mmHg), CO (G1: 6.2 to 5.2 l/min; G2: 6.6 to 5.2 l/min), CI (G1: 3.3 to 2.8 l/min m2; G2: 3.5 to 2.7 l/min m2) and RPP (G1: 12701 to 10201 mmHg min-1; G2: 11309 to 8070 mmHg min-1).(ABSTRACT TRUNCATED AT 250 WORDS)