what is the role of routine use of xylocaine in hypertensive patients

Started by amorrahk, July 30, 2007, 09:35:53 AM

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amorrahk

hi all first,in my hospital in egypt we use xylocaine routinly before intubation and extubation in hypertensive patients and thyroid either euthyroid or thyrotoxic patients,i find it somtimes delay reflexes as i am in need with it for rapid recovery.thank you :)


jafo1964

we pay so much of attention to intubation response but even extubation can produce the same response. Infact post-extubation hypertension affects almost 90% of all patients, thankfully they are self limited. But in a patient at risk to severe hypertension or arrhythmia it may be a good idea to obtund this response. Amongst the various modalities avaliable Lignocard is probabaly the one with the safest risk benefit ratio (other choices would be narcotics, deep extubation, vasodilators, beta blockers)
I fully agree that this can delay recovery and arousal but by how many minutes. Maximum between 5 to 10 minutes. I am sure we can wait for this time with the patient under our supervision. This the average time one has to wait if he does a deep plane extubation with any agent except sevoflurane.
Also xylocard decreases risk of laryngospasm and brochospasm due to stimulation under light planes
We do not use xylocard on all cases but in a patient at risk of adverse CVS or RS complications during the peri-extubation period we use it at 1 - 1.5 mg / kg. After evidence of neuromuscular recovery of diaphragm, We give xylocard before suctioning pharynx and then reverse. Roughly within 5 to 7 mins the patient is recovered enough for extubation.
Lignocard does not block the extubation response completely but helps attenuate the problems related to it
regs