Effect of intravenous lidocaine on the transcerebral inflammatory response during cardiac surgery: a randomized-controlled trial

Abstract

Purpose: Postoperative cognitive dysfunction (POCD) occurs frequently after cardiac surgery. The pathophysiology of POCD remains elusive, but previous work showed that intravenous lidocaine may be protective against POCD, possibly by modulating cerebral inflammation. We hypothesized that intravenous lidocaine would attenuate the cerebral inflammatory response to cardiopulmonary bypass (CPB) by reducing the transcerebral activation gradients of platelets, leukocytes, and/or platelet-leukocyte conjugates.

Methods: We studied 202 patients undergoing cardiac surgery with CPB in this prospective randomized double-blinded placebo-controlled trial. Subjects were randomized to receive either intravenous lidocaine (bolus + 48-hr infusion) or placebo (identical infusion volume and duration). Paired jugular venous and radial arterial blood samples were drawn at several time points and analyzed by fluorescence-activated cell sorting to identify activated platelets and platelet-leukocyte conjugates. Transcerebral activation gradients were calculated by subtracting arterial values from venous values and were compared between groups using repeated measures regression models with covariate adjustment for age, sex, surgery type, and CPB duration.

Results: Beginning after aortic cross-clamp release and peaking ten minutes after the termination of CPB, the mean (SD) transcerebral activation gradient of platelet-monocyte conjugates decreased in lidocaine-treated vs placebo-treated patients [-1.84 (11.47) mean linear fluorescence intensity (MLFI) vs 1.46 (13.88) MLFI, respectively; mean difference, -4.08 MLFI; 95% confidence interval, -7.86 to -0.29; P = 0.03). No difference was seen at any time point for activated platelets or for platelet-neutrophil conjugates.

Conclusion: While lidocaine did not affect the systemic or transcerebral activation of platelets or leukocytes, we did observe a reduction in the transcerebral activation of platelet-monocyte conjugates after aortic cross-clamp release. This may be a manifestation of reduced cerebral inflammation during cardiopulmonary bypass in response to treatment with lidocaine. This trial was registered at ClinicalTrials.gov (NCT00938964).

Conflict of interest statement

Conflicts of interest None declared.

Figures

Fig. 1

CONSORT diagram showing the flow of study participants

Fig. 2

Transcerebral (jugular-arterial) gradient of platelet-monocyte conjugates at baseline, five minutes after release of the aortic cross-clamp (XCR), ten minutes after the termination of cardiopulmonary bypass (EndCPB), and six hours after release of the aortic cross-clamp (6h pXCR) in cardiac surgical patients treated with placebo vs intravenous lidocaine. Error bars denote standard error of the mean. *P = 0.03

Fig. 3

Arterial (A) and jugular (B) levels of platelet-monocyte conjugates at baseline, five minutes after release of the aortic cross-clamp (XCR), ten minutes after the termination of cardiopulmonary bypass (EndCPB), and six hours after release of the aortic cross-clamp (6h pXCR) in cardiac surgical patients treated with placebo vs intravenous lidocaine. Error bars denote standard error of the mean