Intravenous Lidocaine Significantly Reduces the Propofol Dose in Elderly Patients Undergoing Gastroscopy: A Randomized Controlled Trial

Abstract

Objective Propofol-based sedation has been widely used for gastroscopy, but the risk of respiratory suppression in elderly patients should not be overlooked. Intravenous (IV) lidocaine during surgery can reduce the demand for propofol and the incidence of cardiopulmonary complications. We examined whether IV lidocaine reduces the dose of propofol and the occurrence of adverse events during gastroscopy in elderly patients. Methods We conducted a prospective, single-center, double-blind randomized controlled trial in elderly patients aged ≥65 years with ASA I-II. Subjects were randomly assigned to the lidocaine group (Group L, n=70), who received IV 1.5 mg kg −1 lidocaine followed by a continuous infusion of 4 mg kg −1 h −1 lidocaine, or the normal saline group (Group N, n=70), who received an equal volume of saline in the same way. Results IV lidocaine reduced the total and maintenance propofol dose in Group L ( p <0.001), with no significant effect on the induction dose. The incidence of intraoperative hypoxia ( p =0.035), emergency airway management events ( p =0.005), duration of gastroscopy ( p <0.05), consciousness recovery time ( p <0.001), and postoperative pain ( p =0.009) were all reduced in Group L. Patient ( p =0.025) and gastroscopist ( p =0.031) satisfaction was higher in Group L. Intraoperative hemodynamic parameters, the respiratory rate, the incidence of sedation-related events and anesthesiologist satisfaction were similar between the two groups. Conclusion IV lidocaine can significantly reduce the amount of propofol, the incidence of hypoxia and postoperative pain during gastroscopy in elderly patients, with a higher patient and gastroscopist satisfaction.

Effect of intravenous lidocaine on the ED50 of propofol induction dose in elderly patients undergoing painless gastroscopy: a prospective, randomized, double-blinded, controlled study

“…Our study found that the ED50 of propofol induction dose in elderly patients undergoing painless gastroscopy was 0.670 mg/kg when combined with intravenous lidocaine, a significant 40% reduction from the ED50 of 1.118 mg/kg without lidocaine. The finding regarding the propofol-sparing effect of intravenous lidocaine was consistent with previous studies (Chen et al 2020 ; Hu et al 2022 ; Li et al 2022 ). The mechanism underlying this propofol-sparing effect may be attributed to the anti-nociceptive stimulus of lidocaine in this patient group(Hans et al 2010 ).…”

“…Previous researches have demonstrated that intravenous lidocaine effectively reduces propofol consumption, alleviates visceral pain, lowers the occurrence of hypoxia, and promotes faster recovery of bowel function following surgical and endoscopic procedures (Forster et al 2018 ; Gross et al 1983 ; Kaba et al 2007 ; Song et al 2017 ). However, there is little information on the use of intravenous lidocaine in combination with propofol in elderly patients (Hu et al 2022 ). Consequently, the minimum effective dose of propofol when coupled with lidocaine for this specific population undergoing gastroscopy has not yet been defined.…”

Comparing the Effect of Dexmedetomidine Versus Intravenous Lidocaine on Colonoscopy Candidates Under Sedation with Propofol-Fentanyl: A Clinical Trial

“…Lidocaine is an amide local anesthetic that not only inhibits G protein and Nmethyl-D aspartate (NMDA) receptors but also acts through sodium channel blockade (11). Intravenous administration of lidocaine leads to increased concentration of the neurotransmitter acetylcholine in the cerebrospinal fluid (CSF), and this can potentiate the nociceptive pathway (12) and possibly by binding to M3 muscarinic receptors (13), inhibiting glycine receptors (14), and secreting endogenous narcotics, it induces the final analgesic effect (15). Furthermore, as lidocaine comes into contact with the spinal cord, it will lead to direct or indirect reduction of postsynaptic depolarization through NMDA and neurokinin receptors (16).…”