Evaluation of the effect of intravenous lidocaine on propofol requirements during total intravenous anaesthesia as measured by bispectral index

Altermatt, Fernando; Bugedo, Diego A.; Delfino, Alejandro; Solari, Sandra; Guerra, Irene; Muñoz, Hernán R.; Cortínez, Luis Ignacio

doi:10.1093/bja/aes097

Cited by 57 publications

(48 citation statements)

References 18 publications

(9 reference statements)

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“…The use of IV lignocaine has been shown to be associated with a reduced requirement of intravenous anaesthetic agents, specifically propofol [12–15]. Intravenous lignocaine has also been shown to reduce the requirements of volatile anaesthetics in patients undergoing non-abdominal surgeries [16–18], findings similar to the present study.…”

Section: Discussionsupporting

confidence: 84%

The effects of intravenous lignocaine on depth of anaesthesia and intraoperative haemodynamics during open radical prostatectomy

et al. 2017

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BackgroundLignocaine is a local anaesthetic agent, which is also commonly used as a perioperative analgesic adjunct to accelerate rehabilitation and enhance recovery after surgery. Lignocaine’s systemic effects on intraoperative haemodynamics and volatile anaesthetic requirements are not well explored. Therefore, we evaluated the effects of intravenous lignocaine on intraoperative volatile agent requirements and haemodynamics in patients undergoing major abdominal surgery.MethodsWe performed an analysis of 76 participants who underwent elective open radical retropubic prostatectomy. Patients received lignocaine (1.5 mg/kg loading dose) followed by an infusion (1.5 mg/kg/h) for the duration of surgery, or saline at an equivalent rate. The aims of the study were to evaluate the end-tidal sevoflurane concentration required to maintain a bispectral index of between 40 and 60. Measurements included intraoperative blood pressure, heart rate, and the volume of intravenous fluids and dosage of vasoactive medications administered.ResultsThe average end-tidal sevoflurane concentration was lower in the Lignocaine group compared to saline [1.49% (SD: 0.32) vs. 1.89% (SD: 0.29); 95% CI 0.26–0.5, p < 0.001]. In the Lignocaine group, the average mean arterial pressure was 80.3 mmHg (SD: 4.9) compared to 85.1 mmHg (SD: 5.4) in the Saline group (95% CI 2.4–7.1, p < 0.001). Systolic blood pressure was also lower in the Lignocaine group: 121.7 mmHg (SD: 6.1) vs. 128.0 mmHg (SD: 6.4) in the Saline group; 95% CI 3.5–9.2, p < 0.001, as was the mean heart rate [Lignocaine group: 74.9 beats/min (SD: 1.8) vs. 81.5 beats/min (SD: 1.7) in the Saline group, 95% CI 4.1–9.1, p < 0.001]. Maintenance fluid requirements were higher in the Lignocaine group: 3281.1 mL (SD: 1094.6) vs. 2552.6 mL (SD: 1173.5) in the Saline group, 95% CI 206–1251, p = 0.007. There were no differences in the use of vasoactive drugs.ConclusionsIntravenous lignocaine reduces volatile anaesthetic requirements and lowers blood pressure and heart rate in patients undergoing open radical prostatectomy.

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Section: Discussionsupporting

confidence: 84%

The effects of intravenous lignocaine on depth of anaesthesia and intraoperative haemodynamics during open radical prostatectomy

et al. 2017

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“…In another study, in patients undergoing laparoscopic cholecystectomy, the total fentanyl consumption was found to be significantly lower in the lidocaine group (242 ± 48.5 µg vs 323 ± 70.8 µg) [32]. It should be pointed out the evidence for an opioid sparing effect of systemic lidocaine is not consistently clear in the published clinical literature regardless of whether lidocaine is used with volatile or intravenous anesthesia [11,22,23,25,30,33]. However, the evidence is strong in support of the effect of systemic lidocaine in reducing the total dose of volatile anesthetic required for general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…This observation is particularly important for patients with severe coronary artery disease. The protocol of administering a loading dose followed by a continuous IV infusion of lidocaine during general anesthesia has been used in several previous investigations [7,10,11,31,33]. The doses used are calculated to achieve a plasma lidocaine concentration well below the toxic levels (> 5 µg/ml) [7,21].…”

Section: Discussionmentioning

confidence: 99%

Intravenous lidocaine as adjuvant to general anesthesia in renal surgery

Nakhli

Kahloul

Guizani

et al. 2018

Libyan Journal of Medicine

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The role of intraoperative intravenous lidocaine infusion has been previously evaluated for pain relief, inflammatory response, and post-operative recovery, particularly in abdominal surgery. The present study is a randomized double-blinded trial in which we evaluated whether IV lidocaine infusion reduces isoflurane requirement, intraoperative remifentanil consumption and time to post-operative recovery in non-laparoscopic renal surgery. Sixty patients scheduled to undergo elective non-laparoscopic renal surgery under general anesthesia were enrolled to receive either systemic lidocaine infusion (group L: bolus 1.5 mg/kg followed by a continuous infusion at the rate of 2 mg/kg/hr until skin closure) or normal saline (0.9% NaCl solution) (Group C). The depth of anesthesia was monitored using the Bispectral Index Scale (BIS), which is based on measurement of the patient’s cerebral electrical activity. Primary outcome of the study was End-tidal of isoflurane concentration (Et-Iso) at BIS values of 40–60. Secondary outcomes include remifentanil consumption during the operation and time to extubation. Et-Iso was significantly lower in group L than in group C (0.63% ± 0.10% vs 0.92% ± 0.11%, p < 10–3). Mean remifentanil consumption of was significantly lower in group L than in group C (0.13 ± 0.04 µg/kg/min vs 0.18 ± 0.04 µg/kg/min, p < 10–3). Thus, IV lidocaine infusion permits a reduction of 31% in isoflurane concentration requirement and 27% in the intraoperative remifentanil need. In addition, recovery from anesthesia and extubation time was shorter in group L (5.8 ± 1.8 min vs 7.9 ± 2.0 min, p < 10–3). By reducing significantly isoflurane and remifentanil requirements during renal surgery, intravenous lidocaine could provide effective strategy to limit volatile agent and intraoperative opioids consumption especially in low and middle income countries.

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“…Lastly, intravenous lidocaine is a useful adjunct to propofol and remifentanil in TIVA. Lidocaine is an amide-type local anesthetic that reduces the need for both propofol and narcotics; it also suppresses airway reflexes and is an effective post-procedure anti-tussive [98].…”

Section: A Agentsmentioning

confidence: 99%

Anesthesia for Thoracic Surgical Procedures

Tsai¹,

Moon²,

Vachhani³

et al. 2013

Principles and Practice of Cardiothoracic Surgery

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Evaluation of the effect of intravenous lidocaine on propofol requirements during total intravenous anaesthesia as measured by bispectral index

Abstract: † This study shows that i.v. lidocaine reduces propofol requirements during the maintenance of a total i.v. anaesthesia for laparoscopic cholecystectomy.

Cited by 57 publications

References 18 publications

The effects of intravenous lignocaine on depth of anaesthesia and intraoperative haemodynamics during open radical prostatectomy

The effects of intravenous lignocaine on depth of anaesthesia and intraoperative haemodynamics during open radical prostatectomy

Intravenous lidocaine as adjuvant to general anesthesia in renal surgery

Anesthesia for Thoracic Surgical Procedures

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