Haemodynamic effects and the visibility of the surgical field after lidocaine infiltration during septoplasty under general anaesthesia

Background and Purpose: The aim of this study was to determine the effect of local infiltration of adrenaline- containing lidocaine solution during septoplasty under general anaesthesia on systemic haemodynamics and the visibility of the operative field, and to compare it to the topical application of ephedrine. Patients and Methods: A retrospective, comparative, non-randomised, open study on 72 ASA physical status I and II patients, aged 20 to 73 years, scheduled for septoplasty was performed. Lidocaine/adrenaline-ephedrine group (group LA-E; n=18) received four cotton pledgets soaked with 1 % ephedrine, and then the submucosal infiltration of 2% lidocaine containing adrenaline solution (2ml) plus plain 2% lidocaine solution (5ml). Lidocaine/ adrenaline group (LA group; n=25) received the submucosal infiltration of 2% lidocaine containing adrenaline solution (2ml) plus plain 2% lidocaine solution (5ml). Ephedrine group (E group; n=29) received four cotton pledgets soaked with 1% ephedrine. Heart rate (HR) and mean arterial pressure (MAP) were recorded at predetermined time intervals. Bleeding in the surgical field was rated according to a 6-point scale. Results: LA and LA-E groups showed significant lower HR and MAP compared to E-group. LA group showed only slight oscillations in HR. Average bleeding score was 2.28±0.83 in LA-E, 2.08±0.81 in LA and 3.14±0.74 in E group (p<0.001). Conclusions:We demonstrated that infiltration of lidocaine with adrenaline has statistically and clinically better impact on systemic haemodynamics and visibility of the surgical field than that achieved by topical application of ephedrine alone

Combined Usage of Inhaled and Intravenous Milrinone in Pulmonary Hypertension after Heart Valve Surgery

Secondary pulmonary hypertension is a frequent condition after heart valve surgery. It may significantly complicate the perioperative management and increase patients’ morbidity and mortality. The treatment has not been yet completely defined principally because of lack of the selectivity of drugs for the pulmonary vasculature. The usage of inhaled milrinone could be the possible therapeutic option. Inodilator milrinone is commonly used intravenously for patients with pulmonary hypertension and ventricular dysfunction in cardiac surgery. The decrease in systemic vascular resistance frequently necessitates concomitant use of norepinephrine. Pulmonary vasodilators might be more effective and also devoid of potentially dangerous systemic side effects if applied by inhalation, thus acting predominantly on pulmonary circulation. There are only few reports of inhaled milrinone usage in adult post cardiac surgical patients. We reported 2 patients with severe pulmonary hypertension after valve surgery. Because of desperate clinical situation, we decided to use the combination of inhaled and intravenous milrinone. Inhaled milrinone was delivered by means of pneumatic medication nebulizer dissolved with saline in final concentration of 0.5 mg/ml. The nebulizer was attached to the inspiratory limb of the ventilator circuit, just before the Y-piece. We obtained satisfactory reduction in mean pulmonary artery pressure in both patients, and they were successfully extubated and discharged. Although it is a very small sample of patients, we conclude that the combination of inhaled and intravenous milrinone could be an effective treatment of secondary pulmonary hypertension in high-risk cardiac valve surgery patient. The exact indications for inhaled milrinone usage, optimal concentrations for this route, and the beginning and duration of treatment are yet to be determined