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Abstract: Objective: To compare the effects of epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine on propofol requirements, the time to loss of consciousness (LOC), effect-site propofol concentrations, and the hemodynamic variables during induction of general anesthesia guided by bispectral index (BIS) were studied. Methods: Forty-five patients were divided into three groups to receive epidurally administered saline (Group S), 1.5% (w/w) lidocaine (Group L), or 0.5% (w/w) ropivacaine (Group R). propofol infusion was started to produce blood concentration of 4 μg/ml. Once the BIS value reached 40~50, endotracheal intubation was facilitated by 0.1 mg/kg vecuronium. Measurements included the time to LOC, effect-site propofol concentrations, total propofol dose, mean arterial blood pressure (MABP), and heart rate (HR) at different study time points. Results: During induction of anesthesia, both Groups L and R were similar for the time to LOC, effect-site propofol concentrations, total propofol dose, MABP, HR, and BIS. The total doses of propofol administered until 1 min post-intubation were significantly less in patients of Groups R and L compared with Group S. MABP and HR were significantly lower following propofol induction compared with baseline values in the three groups, or MABP was significantly increased following intubation as compared with that prior to intubation in Group S but not in Groups R and L while HR was significantly increased following intubation in the three groups. Conclusion: Epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine has similar effects on the time to LOC, effect-site propofol concentrations, total propofol dose, and the hemodynamic variables during induction of general anesthesia.

[1] Achola, K.J., Jones, M.J., Mitchell, R.W., Smith, G., 1988. Effects of beta-adrenoceptor antagonism on the cardiovascular and catecholamine responses to tracheal intubation. Anaesthesia, 43(6):433-436.

[2] Agarwal, A., Pandey, R., Dhiraaj, S., Singh, P.K., Raza, M., Pandey, C.K., Gupta, D., Choudhury, A., Singh, U., 2004. The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium. Anesth. Analg., 99(6):1684-1688.

[3] Arakawa, M., Avoyama, Y., Ohe, Y., 2003. Efficacy of 1% ropivacaine at sacral segments in lumbar epidural anesthesia. Reg. Anesth. Pain Med., 28(3):208-214.

[4] Bonica, J.J., 1968. Autonomic innervation of the viscera in relation to nerve block. Anesthesiology, 29(4):793-813.

[5] Gaughen, C.M., Durieux, M., 2006. The effect of too much intravenous lidocaine on bispectral index. Anesth. Analg., 103(6):1464-1465.

[6] Glass, P.S.A., Bloom, M., Kearse, L., Rosow, C., Sebel, P., Manberg, P., 1997. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology, 86(4):836-847.

[7] Hassan, H.G., El-Sharkawy, T.Y., Renck, H., Mansour, G., Fouda, A., 1991. Hemodynamic and catecholamine responses to laryngoscopy with vs without endotracheal intubation. Acta Anaesthesiol. Scand., 35(5):442-447.

[8] Himes, R.S., DiFazio, C.A., Burney, R.G., 1977. Effects of lidocaine on the anesthetic requirements for nitrous oxide and halothane. Anesthesiology, 47(5):437-440.

[9] Hodgson, P., Liu, S.S., Gras, T.W., 1999. Does epidural anesthesia have general anesthetic effects? Anesthesiology, 91(6):1687-1692.

[10] Inagaki, Y., Mashimo, M.T., Kuzukava, A., Tsuda, Y., Yoshiya, T., 1994. Epidural lidocaine delays arousal from isoflurane anesthesia. Anesth. Analg., 79(2):368-372.

[11] Irwin, M.G., Hui, T.W., Milne, S.E., Kenny, N., 2002. Propofol effective concentration 50 and its relationship to bispectral index. Anaesthesia, 57(3):242-248.

[12] Ishiyama, T., Kashimoto, S., Oguchi, T., Yamaguchi, T., Okuyama, K., Kumazawa, T., 2005. Epidural ropivacaine anesthesia decreases the bispectral index during the awake phase and sevoflurane general anesthesia. Anesth. Analg., 100(3):728-732.

[13] Jonsson, E.N., Karlsson, M.O., 1999. Xpose—an S-PLUS based population pharmacokinetic/pharmacodynamic model building aid for NONMEM. Comput. Methods Programs Biomed., 58(1):51-64.

[14] Kanata, K., Sakura, S., Kushizaki, H., Nakatani, T., Saito, Y., 2006. Effects of epidural anesthesia with 0.2% and 1% ropivacaine on predicted propofol concentrations and bispectral index values at three clinical end points. J. Clin. Anesth., 18(6):409-414.

[15] Katoh, T., Suzuki, A., Ikeda, K., 1998. Electroencephalographic derivatives as a tool for predicting the depth of sedation and anesthesia induced by sevoflurane. Anesthesiology, 88(3):642-650.

[16] Kearse, L.A.Jr, Rosow, C., Zaslavsky, A., Connors, P., Dershiwitz, M., Denman, W., 1998. Bispectral analysis of electroencephalogram predicts conscious processing of information during propofol sedation and hypnosis. Anesthesiology, 88(1):25-34.

[17] Kreuer, S., Bruhn, J., Larsen, R., Buchinger, H., Wilhelm, W., 2006. A-line, bispectral index, and estimated effect-site concentrations: a prediction of clinical end-points of anesthesia. Anesth. Analg., 102(4):1141-1146.

[18] Liu, S.S., 1998. Local Anesthetics and Analgesia. In: Ashburn, M.A., Rice, L.J. (Eds.), The Management of Pain. Churchill Livingstone Inc., New York, p.141-169.

[19] Lu, C.H., Borel, C.O., Wu, C.T., Yeh, C.C., Jao, S.W., Chao, P.C., Wong, C.S., 2005. Combined general-epidural anesthesia decreases the desflurane requirement for equivalent A-line ARX index in colorectal surgery. Acta Anaesthesiol. Scand., 49(8):1063-1067.

[20] Nakatani, T., Saito, Y., Sakura, S., Kanata, K., 2005. Haemodynamic effects of thoracic epidural anesthesia during induction of anesthesia: an investigation into the effects of tracheal intubation during target-controlled infusion of propofol. Anaesthesia, 60(6):530-534.

[21] Rampil, I.J., 1998. A primer for EEG signal processing in anesthesia. Anesthesiology, 89(4):980-1002.

[22] Senturk, M., Pembeci, K., Menda, F., Ozkan, T., Gucyetmez, B., Tugrul, M., Camci, E., Akpir, K., 2002. Effects of intramuscular administration of lidocaine or bupivacaine on induction and maintenance doses of propofol evaluated by bispectral index. Br. J. Anaesth., 89(6):849-852.

[23] Shribman, A.J., Smith, G., Achola, K.J., 1987. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br. J. Anaesth., 59(3):295-299.

[24] Wattwil, M., Sundberg, A., Olsson, J., Nordstrom, S., 1987. Thoracolumbar epidural anaesthesia blocks circulatory response to laryngoscopy and intubation. Acta Anaesthesiol. Scand., 31(6):529-531.