Impact of lidocaine on hemodynamic and respiratory parameters during laparoscopic appendectomy in children

Abstract

We assessed the influence of systemic lidocaine administration on ventilatory and circulatory parameters, and the pneumoperitoneum impact on the cardiopulmonary system during a laparoscopic appendectomy in children. A single-center parallel single-masked randomized controlled study was carried out with 58 patients (3-17 years). Intravenous lidocaine bolus of 1.5 mg/kg over 5 min before induction of anesthesia followed by lidocaine infusion at 1.5 mg/kg/h intraoperatively. Respiratory system compliance (C, C/kg), Ppeak-PEEP and Pulse rate (Pulse), systolic, diastolic and mean blood pressure (NBPs, NBPd, NBPm), assessed in the Lidocaine and Control group, at the: beginning (P1), minimum lung compliance (P2) and at the end of surgery (P3) were compared. The respiratory/hemodynamic parameters did not differ between the groups at any stage of operation. Blood Pressure and Ppeak-PEEP were significantly higher at the P2 compared to P1 and P3 stages (P < 0.001, 1 - β ≥ 0.895) that correlated with lung compliance changes: C/kg vs. NBPs and Ppeak-PEEP (- 0.42, - 0.84; P < 0.001); C vs. Pulse and Ppeak-PEEP (- 0.48, - 0.46; P < 0.001). Although an increase in intraabdominal pressure up to 12(15) mmHg causes significant changes in hemodynamic/respiratory parameters, there appears to be no risk of fatal reactions in 1E, 2E ASA patients. Systemic lidocaine administration doesn't alleviate circulatory/respiratory alterations during pneumoperitoneum. No lidocaine related episode of anaphylaxis, systemic toxicity, circulatory disturbances or neurological impairment occurred.ClinicalTrials.gov: 22/03/2019.Trial registration number: NCT03886896.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Figure 1

Flow chart of patients included in the study. Of the 74 patients enrolled, 58 were qualified for this study: 29 patients from the Lido group and 29 from the Control group. Hemodynamic parameters and lung compliance were available for 58 patients. However, Ppeak and PEEP were registered in 38 patients (21 from the Lido group and 17 from the Control group).

Figure 2

Study diagram showing key points of the operation: P1, P2, P3. The hemodynamic and respiratory parameters observed at these points were analyzed. Time data are expressed as the median and the range between the first and third quartile: Me (Q1–Q3).

Figure 3

Compliance of respiratory system C, compliance of respiratory system per kg of body mass C/kg at the beginning (P1–baseline), during (P2) and at the end of surgery (P3) in the Lido and Control group. The differences between patients’ groups are insignificant (NS), (a, b). The differences between the P1, P2 and P3 stages are significant (c, d); *P < 0.001 (1 − β  = 0.99 for α = 0.001). The difference between Lido and Control group at the P1, P2 and P3 level is insignificant (NS), (e, f).

Figure 4

Peak pressure (Ppeak) and the peak pressure minus positive end-expiratory pressure (Ppeak-PEEP) in the patient-ventilator system at the beginning (P1−baseline), during (P2) and at the end of surgery (P3) in the Lido and Control group. The differences between patients’ groups are insignificant (NS), (a, b). The differences between the P1, P2 and P3 stages are significant (c, d); *P < 0.001 (1− β = 0.99 for α = 0.001). The difference between Lido and Control group at the P1, P2 and P3 level is insignificant (NS), (e, f).

Figure 5

Systolic and diastolic blood pressure (NBPs, NBPd) at the beginning (P1−baseline), during (P2), and at the end of surgery (P3) in the Lido and Control group. The differences between patients’ groups are insignificant (NS), (a, b). The differences between the P1, P2 and P3 stages are significant (c, d); *P < 0.001 (1 − β = 0.99 and 1 − β = 0.98 for c and d respectively, at α = 0.001). The difference between Lido and Control group at the P1, P2 and P3 level is insignificant (NS), (e, f). #P < 0.05.

Figure 6

Mean blood pressure (NBPm) and pulse rate (Pulse) from SpO2, at the beginning (P1−baseline), during (P2), and at the end of surgery (P3) in the Lido and Control group. The differences between patients’ groups are insignificant (NS), (a, b). The differences between the P1, P2 and P3 stages are significant (c, d). *P < 0.001; 1 − β = 0.97 at α = 0.001 (c); 1 − β = 0.95 at α = 0.05 (d). The difference between Lido and Control group at the P1, P2 and P3 level is insignificant (NS), (e, f). +P < 0.005, #P < 0.05.

Figure 7

Correlation between peak pressure (Ppeak) and respiratory system compliance (C) (a), Ppeak and the respiratory system compliance per kilogram of body mass (C/kg) (b), and between Ppeak-PEEP vs. C (c), and Ppeak-PEEP vs. C/kg (d). Rs—Spearman correlation coefficient, R2—coefficient of determination. *P < 0.001.