Patients and administration of anaesthesia
arteriovenous malformation, colorectal cancer, allergic, liver and kidney dysfunction, abnormal coagulation, mental illness, epilepsy, hereditary mental illness, aneurysmal vascular disease, drug abuse, hypertension, pulmonary arterial hypertension, respiratory and cardiovascular adverse
RESPIRATORY DISEASE, INFECTIOUS DISEASES, COLORECTAL CANCER, ABNORMAL COAGULATION, EPILEPSY, CEREBRAL HAEMORRHAGE, CORONARY HEART DISEASE, CARDIAC ARREST, DYSFUNCTION, CARDIAC INSUFFICIENCY, HYPERTHYROIDISM, ORGANIC DISEASE, PULMONARY ARTERIAL HYPERTENSION, BLOOD, HEART, HYPERTENSION, DISEASES
In this study, patients undergoing laparoscopic radical resection of colorectal cancer were enrolled in The First People’s Hospital of Changde City. Inclusion or exclusion was assessed by a preoperative visit and a medical history review the day before surgery. The inclusion criteria were as follows: (1) Voluntarily participate in this study, have full capacity for civil conduct, and sign informed consent; (2) Patients undergoing elective colorectal surgery in our hospital; (3) Age 18–75 years old, BMI 18–30 kg/m2, ASA grade 1–3; and (4) The patient did not participate in other drug clinical trials nearly 3 months before enrolment. The exclusion criteria were as follows: (1) Patients allergic to lidocaine or amides; (2) Complicated with other vital organ dysfunction, including severe liver and kidney dysfunction; organic diseases of the brain, specifically referring to aneurysmal vascular disease or arteriovenous malformation and cerebral haemorrhage; severe hypertension, coronary heart disease, cardiac insufficiency (New York Heart Association (NYHA) ≥ III), pulmonary arterial hypertension, history of cardiac arrest; diseases of the blood system; abnormal coagulation function; severe respiratory disease; (3) Patients with indoor conduction block; (4) Untreated or undertreated hyperthyroidism; (5) Patients with alcohol or drug dependence or a history of drug abuse; (6) Patients with epilepsy, mental illness and those who take antipsychotic drugs or hereditary mental illness; (7) Those with serious infectious diseases; and (8) Patients considered unsuitable for inclusion by other researchers. The random number table method was used to randomly assign patients at a ratio of 1:1. The randomization of the sequence and the allocation of masking (placed in sealed envelopes) was performed by a trained professional researcher. Dedicated staff obtained each random assignment according to the assignment table and prepared the trial drug prior to the start of anaesthesia. All patients received the trial drug in a normal saline configuration. Full-time staff did not participate in the entire anaesthesia operation process, nor did they participate in the postoperative follow-up work. All perioperative data were followed up and collected by trained and qualified research nurses who did not participate in the randomization and anaesthetic operations. None of the researchers or patients involved in the trial were aware of the drug being studied. Neither the patient nor the data collector knew which drug the patient was taking to keep the study double-blind. In this study, the anaesthesia and operations were performed by fixed personnel, and the treatment assignment was not known.No benzodiazepines or anxiolytic medication were used before surgery. ECG monitoring was performed routinely after the patient entered the room. The induction of anaesthesia was as follows: midazolam (1–2 mg), sufentanil (0.3 µg/kg), cisatracurium (0.15 mg/kg), propofol (1.5–2.5 mg/kg) or etomidate (0.15–0.3 mg/kg). The anaesthesia maintenance was as follows: remifentanil (0.1–0.5 µg/kg/min), propofol (50–150 µg/kg/min), sevoflurane (1.5 to 2.0 minimum alveolar concentrations), with appropriate addition of cis-atracurium. When the intraoperative mean arterial pressure(MAP) increased by more than 20% of the basic MAP, remifentanil was given 30ug and increased by 0.03ug/Kg.min every 5 min until the MAP recovered to within 20% of the basic MAP. When the intraoperative MAP decreased by more than 20% of the basic MAP, remifentanil was down-regulated by 0.03ug/Kg.min every 5 min, and the minimum remifentanil was decreased to 0.1ug/Kg.min. Mechanical ventilation was performed after endotracheal intubation. The respiratory parameters were set as follows: ventilation frequency f was 12 times/min, tidal volume VT was 8 ml/kg, suction/breathing ratio I:E was 1:2, and the end-tidal pressure of carbon dioxide was between 35 and 45 mmHg. Intraoperative lactated Ringer’s solution was given at a dose of 20 ml/kg (1000 ml oral energy drink 2 h before surgery). During surgery, the BIS value was maintained at 40–60 by adjusting the anaesthetic. Blood pressure was maintained within ± 20% of the baseline blood pressure, nasopharyngeal temperature was controlled at 36-37.5 °C, and intraoperative blood glucose was controlled at 3.9–11.1 mM. During the operation, 1 mg methoxamine hydrochloride injection was injected when the blood pressure was 20% below the baseline level, 10 mg urapidil injection was injected when the blood pressure was 20% above the baseline level, 0.3 mg atropine injection was injected when the heart rate was below 50/min, and 10 mg esmolol hydrochloride injection was injected when the heart rate was above 110/min. Other respiratory and cardiovascular adverse events were recorded and treated according to clinical practice.In the lidocaine group, 2 mg/kg lidocaine was injected intravenously 30 min before anaesthesia, and 2 mg/kg/h lidocaine was injected intravenously through an intravenous pump until the end of the operation. The control group was given an equal volume of normal saline in the same way at the same time point. Sufentanil was injected with a patient-controlled analgesia pump for postoperative analgesia at 48 h.