Administration of lidocaine to prevent cognitive deficit in patients undergoing coronary artery bypass grafting and valve plasty: a systematic review and meta-analysis

Baradari, Afshin Gholipour; Habibi, Mohammad Reza; Hassani, Valiollah; Nouraei, Seyed Mahmoud

doi:10.1080/17512433.2017.1266252

Cited by 19 publications

(13 citation statements)

References 29 publications

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“…Our approach to OFA was based on published literature which demonstrates that each of the effects associated with opioids can be obtained with lidocaine (analgesic, hypnotic, and ANS control), dexamethasone (analgesic) and ketamine (analgesic and hypnotic) [11–13]. The lidocaine dosing regimen was based on the literature published since the 1990s that has demonstrated a safety profile with continuous infusion of lidocaine during cardiac and non-cardiac surgeries [27, 28]. Lidocaine has effects that depend on the total dose, and detrimental effects can be seen with elevated doses of lidocaine [27].…”

Section: Discussionmentioning

confidence: 99%

“…Lidocaine has effects that depend on the total dose, and detrimental effects can be seen with elevated doses of lidocaine [27]. But lidocaine also has beneficial effects during surgery, providing (a) an anti-inflammatory effect; (b) an increase in the cardioprotective effect of cardioplegia; (c) a decrease in the risk of arrhythmias; and (d) a decrease in the risk of brain inflammation [15, 16, 28, 29].…”

Section: Discussionmentioning

confidence: 99%

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Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study

et al. 2019

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Background No study has been conducted to demonstrate the feasibility of an opioid-free anesthesia (OFA) protocol in cardiac surgery to improve patient care. The aim of the present study was to evaluate the effect of OFA on post-operative morphine consumption and the post-operative course. Methods After retrospectively registering to clinicaltrial.gov (NCT03816592), we performed a retrospective matched cohort study (1:1) on cardiac surgery patients with cardiopulmonary bypass between 2018 and 2019. Patients were divided into two groups: OFA (lidocaine, dexamethasone and ketamine) or opioid anaesthesia (OA) (sufentanil). The main outcome was the total postoperative morphine consumption in the 48 h after surgery. Secondary outcomes were rescue analgesic use, a major adverse event composite endpoint, and ICU and hospital length of stay (LOS). Results One hundred ten patients were matched (OFA: n = 55; OA: n = 55). On inclusion, demographic and surgical data for the OFA and OA groups were comparable. The total morphine consumption was higher in the OA group than in the OFA group (15 (6–34) vs 5 mg (2–18), p = 0.001). The pain score during the first 48 post-operative hours did not differ between the two groups. Creatinine values did not differ on the first post-operative day (80 (IQR: 66–115) vs 77 mmol/l (IQR: 69–95), p = 0.284). Incidence of the composite endpoint was lower in the OFA group (25 patients (43%) vs 38 patients (68%), p = 0.021). The time to extubation and the ICU stays were shorter in the OFA group (3 (1–5) vs 5 (3–6) hours, p = 0.001 and 2 (1–3) vs 3 (2–5) days, p = 0.037). Conclusion The use of OFA was associated with lower morphine consumption. OFA might be associated with shorter intubation time and ICU stays. Further randomized studies are needed to confirm these results. Trial registration This study was retrospectively registered to ct2 (identifier: NCT03816592 ) on January 25, 2019.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study

et al. 2019

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“…Many studies have shown that intraoperative IV lidocaine administration provides a statistically significant positive effect on p/o analgesia: it contributes to a potential reduction in overall opioid consumption; reduces the duration of intestinal paresis; has an anti-inflammatory effect; increases the cardioprotective effect of cardioplegia; reduces the risk of arrhythmias; reduces the risk of brain inflammation (neuroprotective effects) [ 18 , 19 ]; reduces circulating inflammatory cytokines and prevents secondary hyperalgesia and central sensitization, and reduces patients’ hospital stay [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

The use of multimodal low-opioid anesthesia for coronary artery bypass grafting surgery in conditions of artificial blood circulation

Loskutov¹,

Danchyna²,

Dzuba³

et al. 2020

kitp

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Introduction Cardiovascular diseases (CVD) are the main cause of death worldwide, and according to experts, they will continue to dominate the structure of global mortality. Aim The effectiveness of the multimodal low-opioid anesthesia technique in performing coronary artery bypass graft operations with artificial blood circulation. Material and methods Ninety-six patients aged 61.8 ±10.4 years underwent coronary artery bypass grafting under artificial blood circulation. Group I: propofol, sevoflurane, fentanyl, pipecuronium bromide (standard doses). Group II: dexketoprofen trometamol (50 mg), intravenous lidocaine (1% – 1 mg/kg bolus) and continuous lidocaine infusion (1.5–2 mg/kg/h), propofol, ketamine (0.5 mg/kg), magnesia sulfate, minimal doses of fentanyl. Results Average duration of anesthesia – 257.4 ±19.1 min; assisted blood circulation – 55 ±10 min. Mean dose of fentanyl in group I – 4.66 ±1.58 µg/kg/h, in group II – 1.29 ±0.32 µg/kg/h.Standard lab values and stress hormonal changes were within the normal range (mean cortisol: 479.3 ±26.4 nmol/l, lactate 1.61 ±0.2 mmol/l, glucose 6.42 ±0.9 mmol/l). Changes in heart rate within group I had a significant amplitude of dynamics, while in group II, these values were relatively at the same level throughout the entire anesthetic provision. Mean arterial pressure changes in group I were characterized by a significant reduction at the stage of induction, support and sternum reduction, whereas in group II it was relatively at the same level during the entire anesthetic management and significantly differed from baseline only at the stage of induction. Conclusions Multimodal low-opioid anesthesia during coronary artery bypass surgery with artificial blood circulation allows one to ensure adequate analgesia and avoid the intraoperative usage of routine doses of fentanyl, as indicated by the absence of hemodynamic and endocrine-metabolic changes.

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“…They also reported that there is a decline in half of the routinely used tests in the first week after CPB surgery, specifically in measures that assess psychomotor function [1] . Moreover, the practice effect indicates that the results of patients with POCD may be confounded by the results of patients who showed practice effects over multiple testing sessions [2] . However, the improvement in the declining trend in POCD after CABG surgery may be originated from the learning effect.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative cognitive deficit (POCD) has long been considered a major complication after cardiac surgery [1,2] . Microemboli are assumed to be a key factor in development of brain injury after cardiopulmonary bypass (CPB) surgery [3] , but to date the root cause of POCD and relevant risk factors have been poorly differentiated [4] .…”

Section: Introductionmentioning

confidence: 99%

Neuroprotective Effect of Low Mean Arterial Pressure on Postoperative Cognitive Deficit Attenuated by Prolonged Coronary Artery Bypass Time: A Meta-Analysis

Kiabi

Soleimani

Habibi

2019

Braz J Cardiovasc Surg

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Introduction The true influence of the low mean arterial pressure (low MAP) during coronary artery bypass grafting (CABG) on the development of postoperative cognitive deficit (POCD) remains controversial. We aimed to perform a meta-analysis and meta-regression to determine the effect of low MAP on POCD, as well as moderator variables between low MAP and POCD.Methods The Web of Science, PubMed database, Scopus and the Cochrane Library database (up to June 2018) were searched and retrieved articles systematically reviewed. Only randomized controlled trials (RCTs) comparing maintenance of low MAP (<80 mmHg) and high MAP (>80 mmHg) during cardiopulmonary bypass (CPB) were included in our final review. Statistical analysis of the risk ratio (RR) and corresponding 95% confidence interval (CI) was used to report the overall effect. The overall effect and meta-regression analysis were done using Mantel-Haenszel risk ratio (MHRR) and the corresponding 95% confidence interval (CI).Results A total of 731 patients in three RCTs were included in this study. POCD occurred in 6.4% of all cases. Maintenance of low MAP did not reduce the occurrence of POCD (MHRR 1.012 [95% CI 0.277-3.688]; Z=0.018; P=0.986; I2=66%). Shorter CPB time reduced the occurrence of POCD regardless of group assignment (MH log risk ratio -0.519 [95% CI -0.949 - -0.089]; Z= -2.367; P=0.017).Conclusion POCD is a common event among CABG patients. The neuroprotective effect of low MAP on POCD was attenuated by the prolonged CPB time.

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Administration of lidocaine to prevent cognitive deficit in patients undergoing coronary artery bypass grafting and valve plasty: a systematic review and meta-analysis

Cited by 19 publications

References 29 publications

Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study

Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study

The use of multimodal low-opioid anesthesia for coronary artery bypass grafting surgery in conditions of artificial blood circulation

Neuroprotective Effect of Low Mean Arterial Pressure on Postoperative Cognitive Deficit Attenuated by Prolonged Coronary Artery Bypass Time: A Meta-Analysis

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