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

Song Hu, Mingxia Wang, Siyu Li, Wenyu Zhou, Yi Zhang, Haobing Shi, Pengcheng Ye, Jixiong Sun, Feng Liu, Wei Zhang, Li Zheng, Qianhao Hou, Yue Wang, Weixin Sun, Yuanli Chen, Zhenzhen Lu, Zhonghua Ji, Lijun Liao, Xin Lv, Yinglin Wang, Xiangrui Wang, Hao Yang, Song Hu, Mingxia Wang, Siyu Li, Wenyu Zhou, Yi Zhang, Haobing Shi, Pengcheng Ye, Jixiong Sun, Feng Liu, Wei Zhang, Li Zheng, Qianhao Hou, Yue Wang, Weixin Sun, Yuanli Chen, Zhenzhen Lu, Zhonghua Ji, Lijun Liao, Xin Lv, Yinglin Wang, Xiangrui Wang, Hao Yang

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.

Keywords: elderly patient; gastroscopy; lidocaine; propofol; sedation.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2022 Hu et al.

Figures

Figure 1
Figure 1
CONSORT flow chart of the procedures for patients undergoing gastroscopy.
Figure 2
Figure 2
Hemodynamic parameters and respiratory rate of patients.
Figure 3
Figure 3
Postoperative pain scores.

References

    1. Shao LJ, Zou Y, Liu FK, et al. Comparison of two supplemental oxygen methods during gastroscopy with propofol mono-sedation in patients with a normal body mass index. World J Gastroenterol. 2020;26(43):6867–6879. doi:10.3748/wjg.v26.i43.6867
    1. Cai G, Huang Z, Zou T, et al. Clinical application of a novel endoscopic mask: a randomized controlled trial in aged patients undergoing painless gastroscopy. Int J Med Sci. 2017;14(2):167–172. doi:10.7150/ijms.16919
    1. Hao L, Hu X, Zhu B, Li W, Huang X, Kang F. Clinical observation of the combined use of propofol and etomidate in painless gastroscopy. Medicine. 2020;99(45):e23061. doi:10.1097/MD.0000000000023061
    1. Abdelmalak BB, Cata JP, Bonilla A, et al. Intraoperative tissue oxygenation and postoperative outcomes after major non-cardiac surgery: an observational study. Br J Anaesth. 2013;110(2):241–249. doi:10.1093/bja/aes378
    1. Chiumello D, Brioni M. Severe hypoxemia: which strategy to choose. Crit Care. 2016;20(1):132. doi:10.1186/s13054-016-1304-7
    1. Padiyara TV, Bansal S, Jain D, Arora S, Gandhi K. Dexmedetomidine versus propofol at different sedation depths during drug-induced sleep endoscopy: a randomized trial. Laryngoscope. 2020;130(1):257–262. doi:10.1002/lary.27903
    1. Edokpolo LU, Mastriano DJ, Serafin J, Weedon JC, Siddiqui MT, Dimaculangan DP. Discharge readiness after propofol with or without dexmedetomidine for colonoscopy: a randomized controlled trial. Anesthesiology. 2019;131(2):279–286. doi:10.1097/ALN.0000000000002809
    1. Yin S, Hong J, Sha T, et al. Efficacy and tolerability of sufentanil, dexmedetomidine, or ketamine added to propofol-based sedation for gastrointestinal endoscopy in elderly patients: a prospective, randomized, controlled trial. Clin Ther. 2019;41(9):1864–1877.e1860. doi:10.1016/j.clinthera.2019.06.011
    1. Beaussier M, Delbos A, Maurice-Szamburski A, Ecoffey C, Mercadal L. Perioperative use of intravenous lidocaine. Drugs. 2018;78(12):1229–1246. doi:10.1007/s40265-018-0955-x
    1. Ness TJ. Intravenous lidocaine inhibits visceral nociceptive reflexes and spinal neurons in the rat. Anesthesiology. 2000;92(6):1685–1691. doi:10.1097/00000542-200006000-00028
    1. Kaba A, Laurent SR, Detroz BJ, et al. Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. Anesthesiology. 2007;106(1):11–18; discussion 15–16. doi:10.1097/00000542-200701000-00007
    1. Labaille T, Clergue F, Samii K, Ecoffey C, Berdeaux A. Ventilatory response to CO2 following intravenous and epidural lidocaine. Anesthesiology. 1985;63(2):179–183. doi:10.1097/00000542-198508000-00011
    1. Forster C, Vanhaudenhuyse A, Gast P, et al. Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study. Br J Anaesth. 2018;121(5):1059–1064. doi:10.1016/j.bja.2018.06.019
    1. Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg. 2012;10(1):28–55. doi:10.1016/j.ijsu.2011.10.001
    1. Cohen LB, Delegge MH, Aisenberg J, et al. AGA Institute review of endoscopic sedation. Gastroenterology. 2007;133(2):675–701. doi:10.1053/j.gastro.2007.06.002
    1. Mason KP, Green SM, Piacevoli Q. Adverse event reporting tool to standardize the reporting and tracking of adverse events during procedural sedation: a consensus document from the world SIVA international sedation task force. Br J Anaesth. 2012;108(1):13–20. doi:10.1093/bja/aer407
    1. Yan JW, McLeod SL, Iansavitchene A. Ketamine-propofol versus propofol alone for procedural sedation in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2015;22(9):1003–1013. doi:10.1111/acem.12737
    1. Altermatt FR, Bugedo DA, Delfino AE, et al. Evaluation of the effect of intravenous lidocaine on propofol requirements during total intravenous anaesthesia as measured by bispectral index. Br J Anaesth. 2012;108(6):979–983. doi:10.1093/bja/aes097
    1. Wang J, Duan J, Xie C, Yu Y, Lu Y. Comparison between intravenous nalbuphine and lidocaine in reducing propofol-induced injection pain during gastroscopy: a randomized controlled trial. Pain Ther. 2020;9(2):563–571. doi:10.1007/s40122-020-00188-y
    1. Li X, Lv X, Jiang Z, et al. Application of intravenous lidocaine in obese patients undergoing painless colonoscopy: a prospective, randomized, double-blind, controlled study. Drug Des Devel Ther. 2020;14:3509–3518. doi:10.2147/DDDT.S266062
    1. Chen M, Lu Y, Liu H, et al. The propofol-sparing effect of intravenous lidocaine in elderly patients undergoing colonoscopy: a randomized, double-blinded, controlled study. BMC Anesthesiol. 2020;20(1):132. doi:10.1186/s12871-020-01049-z
    1. Liu J, Liu X, Peng LP, Ji R, Liu C, Li YQ. Efficacy and safety of intravenous lidocaine in propofol-based sedation for ERCP procedures: a prospective, randomized, double-blinded, controlled trial. Gastrointest Endosc. 2020;92(2):293–300. doi:10.1016/j.gie.2020.02.050
    1. Liu H, Chen M, Lian C, Wu J, Shangguan W. Effect of intravenous administration of lidocaine on the ED50 of propofol induction dose during gastroscopy in adult patients: a randomized, controlled study. J Clin Pharm Ther. 2021;46(3):711–716. doi:10.1111/jcpt.13335
    1. Hung KC, Yew M, Lin YT, et al. Impact of intravenous and topical lidocaine on clinical outcomes in patients receiving propofol for gastrointestinal endoscopic procedures: a meta-analysis of randomised controlled trials. Br J Anaesth. 2022;128(4):644–654. doi:10.1016/j.bja.2021.08.036
    1. Qadeer MA, Lopez AR, Dumot JA, Vargo JJ. Hypoxemia during moderate sedation for gastrointestinal endoscopy: causes and associations. Digestion. 2011;84(1):37–45. doi:10.1159/000321621
    1. Mortero RF, Clark LD, Tolan MM, Metz RJ, Tsueda K, Sheppard RA. The effects of small-dose ketamine on propofol sedation: respiration, postoperative mood, perception, cognition, and pain. Anesth Analg. 2001;92(6):1465–1469. doi:10.1097/00000539-200106000-00022
    1. Gross JB, Caldwell CB, Shaw LM, Laucks SO. The effect of lidocaine on the ventilatory response to carbon dioxide. Anesthesiology. 1983;59(6):521–525. doi:10.1097/00000542-198312000-00006
    1. Haines DJ, Bibbey D, Green JR. Does nasal oxygen reduce the cardiorespiratory problems experienced by elderly patients undergoing endoscopic retrograde cholangiopancreatography? Gut. 1992;33(7):973–975. doi:10.1136/gut.33.7.973
    1. Wani S, Azar R, Hovis CE, et al. Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures. Gastrointest Endosc. 2011;74(6):1238–1247. doi:10.1016/j.gie.2011.09.006
    1. Lévy P, Kohler M, McNicholas WT, et al. Obstructive sleep apnoea syndrome. Nat Rev Dis Primers. 2015;1:15015. doi:10.1038/nrdp.2015.15
    1. Marik PE. Propofol: therapeutic indications and side-effects. Curr Pharm Des. 2004;10(29):3639–3649. doi:10.2174/1381612043382846
    1. Sahinovic MM, Struys M, Absalom AR. Clinical pharmacokinetics and pharmacodynamics of propofol. Clin Pharmacokinet. 2018;57(12):1539–1558. doi:10.1007/s40262-018-0672-3
    1. Nordmark J, Rydqvist B. Local anaesthetics potentiate GABA-mediated Cl- currents by inhibiting GABA uptake. Neuroreport. 1997;8(2):465–468. doi:10.1097/00001756-199701200-00018
    1. Hans GA, Lauwick SM, Kaba A, et al. Intravenous lidocaine infusion reduces bispectral index-guided requirements of propofol only during surgical stimulation. Br J Anaesth. 2010;105(4):471–479. doi:10.1093/bja/aeq189
    1. Zhou X, Li BX, Chen LM, et al. Etomidate plus propofol versus propofol alone for sedation during gastroscopy: a randomized prospective clinical trial. Surg Endosc. 2016;30(11):5108–5116. doi:10.1007/s00464-016-4861-6

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