Abstract
The effect of systemically administered lidocaine on somatosensory evoked potentials (SSEPs) during general anaesthesia has not been widely reported. Knowledge of the influence of anaesthetic agents on evoked potentials assists in interpreting evoked potential waveforms. Accordingly, we studied the behaviour of cortical and subcortical (recorded at the second cervical vertebra) SSEPs after administration of intravenous lidocaine (3 mg · kg−1 bolus followed by infusion at 4 mg · kg−1 · hr−1) during a sufentanil-based anaesthetic regimen in 16 patients undergoing abdominal or orthopaedic surgery. When compared to awake baseline recordings, the sufentanil-nitrous oxide, low-dose isoflurane anaesthetic depressed N1 amplitude by approximately 40% and prolonged latency by 10%. Fifteen minutes after establishment of this anaesthetic, the amplitude and latency of N1 were 1.13 ± 0.56 μV and 19.81 ± 1.63 msec, respectively. Within five minutes of adding lidocaine, amplitude decreased further to 0.84 ± 0.39 μV (P = 0.001), while latency was extended to 20.44 ± 1.48 msec (P = 0.01). Lidocaine did not affect cervical amplitude and prolonged latency only minimally. Despite the observed effects on amplitude and latency, SSEP waveforms were preserved and interpretable. Plasma lidocaine levels obtained at 5, 20, and 40 minutes after lidocaine were 5.17 ± 1.33, 3.76 ± 1.14, and 3.66 ± 0.9 μg · dl−1, respectively. Our results indicate that systemically administered lidocaine at therapeutic plasma levels acts synergistically with a sufentanilbased anaesthetic to depress the amplitude and prolong the latency of SSEPs.
Résumé
Il existe peu de publications sur l’effet de la lidocaine administrée par voie systemique sur les potentiels évoqués somatosensitifs (SSEP) pendant l’anesthésie générate. La connaissance des effets des agents anesthésiques sur les potentiels évoqués aide à l’interprétation des ondes de potentiels évoqués. Nous avons étudié l’effet de bl’administration de lidocaine par voie intraveineuse (bolus de 3 mg · kg−1 suivi d’une perfusion de 4 mg · kg−1 · h−1) sur les SSEP corticaux et sous-corticaux (enregistre au niveau de la deuxieme vertebre cervical) chez 16 patients anesthésiés avec une technique à base de sufentanil pendant une chirurgie abdominale ou orthopédique. Comparativement aux enregistrements de base en etat d’éveil, l’anesthésie à l’aide de sufentanil-protoxyde d’azote et faible dose d’isoflurane déprimait l’amplitude N1 d’environ 40% et prolongeait la latence de 10%. Après 15 minutes d’anesthésie, l’amplitude et la latence de Nl étaient de 1,13 ± 0,56 μV et 19,81 ± 1,63 msec respectivement. Cinq minutes après l’addition de lidocaine, l’amplitude a diminue a 0,84 ± 0,39 μV (P < 0,001) tandis que la latence a augmente a 20,44 ± 1,48 msec (P < 0,01). La lidocaine n ’a pas affecté l’amplitude cervical et a très peu prolonge la latence. Malgré les effets observés sur l’amplitude et la latence, les ondes SSEP étaient préservées et interprétables. Les niveaux plasmatiques de lidocaïne à 5, 20 et 40 minutes après l’injection étaient de 5,17 ± 1,33, 3,76 ± 1,14 et 3,66 ± 0,9 μg · dr−1 respectivement. Nos résultats démontrent que la lidocaine administree par voie systémique à des niveaux plasmatiques thérapeutiques agit en synergie avec une technique anesthésique à base de sufentanil en provoquant une dépression de l’amplitude et une prolongation de la latence des SSEP.
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Schubert, A., Licina, M.G., Glaze, G.M. et al. Systemic lidocaine and human somatosensoryevoked potentials during sufentanil-isoflurane anaesthesia. Can J Anaesth 39, 569–575 (1992). https://doi.org/10.1007/BF03008320
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DOI: https://doi.org/10.1007/BF03008320