The Effects of Pre-incisional Lidocaine Infiltration into Tonsils with Low-dose Fentanyl Supplementation on the Blood pressure and the Heart rate for Pediatric Adenotonsillectomy

Song, Jang Ho; Kim, Hae Kyoung; Lee, Hong Sik; chung, Choon Kun

Abstract

The purpose of this study was to evaluate the effects of pre-incisional lidocaine injected into tonsils with low-dose fentanyl supplementation on the cardiovascular stability and on the developrnent of intraoperative arrhythmia for pediatric adenotonsillectomy under general anesthesia. Thirty-three pediatric patients undergoing adenotonsillectomy under general anesthesia were randomly aUocated to one of the 3 groups according to the medications used for anesthesia.; 1) N2-O2-halothane only, 2) N2-O2-halothane plus pre-incisional infiltration of 2% lidocaine and 1: 80,000 epinephrine into tonsils after tracheal intubation, 3) N2-O2-halothane plus 2 mcg/kg intravenous fentanyl before induction of anesthesia plus pre-incisional infiltration of 2% lidocaine and 1: 80,000 epinephrine into tonsils after tracheal intubation. All Patients received (0.01/kg+0.15) mg atropine sulfate and 5 mg/kg thipental sodium and inhaled N2-O2-halothane (2 L-2 L-2 vol%) for induction. Tracheal intubation was facilitated with 1.5 mg/kg succinylcholine. After tracheal intubation, anesthesia was maintained with 5% N2O in oxygen and 1 vo1% halothane. 0.1 mg/kg vecuronium was used for myorelaxation. SBP, DBP, MAP, and HR were measured at 1 min, 3 min after intubation, immediately after the incision of tonsils, and after the position change of endotracheal tube. ECG changes were also observed during surgery. After surgery, the degree of irritability and the recovery time were evaluated in all patients in the recovery room. The results were as follows; 1) In Gmup 3, the increases of systolic BP at 3 min and HR at 1 min after tracheal intubation were significantly lower than other two groups. 2) The maximum value of intraoperative systolic BP was the highest in Group 1, followed by Group 2, and then Group 3. 3) The peak intraoperative HR attained was the lowest in Group 3. Difference between Group 1 and 2 was not significant. 4) No cardiac arrhythmia was present in Group 3, 5) The degree of postaperative imtabiTity was the lowest in Gmup 3 and the highest in Group 1. In conclusion, these results indicate that supplementation of low-dose fentanyl and preincisional infiltration of tonsils with lidocaine for pediatric adenotosillectomy under genral anesthesia is useful in reducing cardiovascular instability during tracheal intubation and surgery as well as the incidence of intraoperative cardiac arrhythmia, and postoperative pain.