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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), P_peak-PEEP and Pulse rate (Pulse), systolic, diastolic and mean blood pressure (NBP_s, NBP_d, NBP_m), 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 P_peak-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. NBP_s and P_peak-PEEP (- 0.42, - 0.84; P < 0.001); C vs. Pulse and P_peak-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.

SUBMITTER: Kaszynski M

PROVIDER: S-EPMC9388633 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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

Kaszyński Maciej M Stankiewicz Barbara B Pałko Krzysztof Jakub KJ Darowski Marek M Pągowska-Klimek Izabela I

Scientific reports 20220818 1

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 comp ...[more]

PMID: 35982198

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Project description:Intravenous lidocaine, a potent local anesthetic with analgesic and anti-inflammatory properties, has been shown to be an effective adjunct that reduces intra- and postoperative opioid consumption and facilitates pain management in adults. While it shows promise for use in the pediatric population, limited evidence is available.ObjectivesTo determine if general anesthesia with intraoperative intravenous lidocaine infusion versus general anesthesia without intravenous lidocaine infusion in children undergoing laparoscopic appendectomy decreased opioid requirements intra- and postoperatively.DesignA single-center parallel single-masked randomized controlled study. A computer-generated blocked randomization list was used to allocate participants. The study was conducted between March 2019 and January 2020.SettingPediatric teaching hospital in Poland.ParticipantsSeventy-four patients aged between 18 months and 18 years undergoing laparoscopic appendectomy. Seventy-one patients fulfilled the study requirements.InterventionIntravenous 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. The infusion was discontinued before the patients' transfer to the postanesthesia care unit (PACU).Primary outcome measureThe primary outcome measure was total nalbuphine requirement in milligrams during the first 24 h after surgery.Secondary outcome measuresThe secondary outcome measures were intraoperative fentanyl consumption, intraoperative sevoflurane consumption, time to the first rescue analgesic request, incidence of postoperative nausea and vomiting during the first 24 h after surgery, frequency of side effects of lidocaine.ResultsChildren (n = 74) aged 5-17 randomly allocated to receive intraoperative lidocaine infusion (n = 37) or no intervention (n = 37). Seventy-one were included in the analysis (35 in the study group and 36 in the control group). There was no difference in the cumulative dose of nalbuphine in the first 24 h after removal of the endotracheal tube between groups [median of 0.1061 (IQR: 0.0962-0.2222) mg/kg in the lidocaine group, compared to the control group median of 0.1325 (IQR: 0.0899-0.22020) mg/kg, p = 0.63]. Intraoperative fentanyl consumption was lower in the lidocaine group [median of 5.091 (IQR: 4.848-5.714) μg/kg] than in the control group [median of 5.969 (IQR: 5.000-6.748), p = 0.03]. Taking into account the additional doses administered based on clinical indications, the reduction in the requirement for fentanyl in the lidocaine group was even greater [median of 0.0 (IQR: 0.0-0.952) vs 0.99 (IQR: 0.0-1.809) μg/kg, p = 0.01]. No difference was observed in the sevoflurane consumption between the two groups [median of 32.5 ml (IQR 25.0-43.0) in the lidocaine group vs median of 35.0 ml (IQR: 23.5-46.0) in the control group, p = 0.56]. The time to first analgesic request in the lidocaine group was prolonged [median of 55 (IQR: 40-110) min in the lidocaine group vs median of 40.5 (IQR: 28-65) min in the control group, p = 0.05]. There was no difference in the frequency of PONV between the two groups (48.57% in the lidocaine group vs 61.11% in the control group, p = 0.29). No lidocaine related incidence of anaphylaxis, systemic toxicity, circulatory disturbances or neurological impairment was reported, during anesthesia or postoperative period.ConclusionsIntraoperative systemic lidocaine administration reduced the intraoperative requirement for opioids in children undergoing laparoscopic appendectomy. This effect was time limited, and hence did not affect opioid consumption in the first 24 h following discontinuation of lidocaine infusion.Trial registrationNCT03886896 .

Project description:Laparoscopic appendectomy (LA) is one of the most commonly performed surgical procedures in children and is associated with extreme postoperative discomfort due to peritoneal inflammation and infection. The main objective of this study was to investigate the effects of postoperative pain (POP) in children after laparoscopic appendectomy. Articles describing or evaluating the control of POP in children with LA were considered eligible. All available literature such as randomized controls, prospective controls, retrospective as well as clinical studies were considered. A comprehensive search was performed in PubMed, Medline, Embase, Cochrane Library, Clinical trials.gov, and Google scholar. The initial search took place on 23 April 2021, and was updated on 24 August 2021. There were no language or date restrictions. Each of the included articles was evaluated separately by two independent reviewers. Additional papers were found by searching the reference lists of eligible studies. Eighteen papers were considered. All papers, and many of them used different methods to treat POP in children undergoing LA, such as lidocaine infusion, different analgesic approaches, ultrasound-guided transverse abdominis blockade (UGTAP), ultrasound-guided quadratus lumborum blockade (UGQLB), and comparison of open appendectomy (OA) with local anesthetics in relation to POP management in children. Laparoscopic appendectomy is the surgical procedure preferred by clinicians compared with open appendectomy in children. A multimodal analgesic approach is optimal and efficient surgical techniques such as UGBRSB, UGQLB, and UGTAP block might significantly impact POP in children except that there are contraindications. Dexmedetomidine proved to be an effective adjuvant that can enhance the effect of local anesthetics. The lack of a sufficient number of studies may be a factor affecting our confidence in the results of this study. Therefore, further evidence-based randomized control trials with a large sample size are needed to provide clarity.

Project description:Race and ethnicity are associated with disparities in pain management in children. While low English language proficiency is correlated with minority race/ethnicity in the United States, it is less frequently explored in the study of health disparities. We therefore investigated whether English language proficiency influenced pain management in the post-anesthesia care unit (PACU) in a cohort of children who underwent laparoscopic appendectomy at our pediatric hospital in San Francisco. Our primary exposure was English language proficiency, and our primary outcome was administration of any opioid medication in the PACU. Secondary outcomes included the amount of opioid administered in the PACU and whether any pain score was recorded during the patient's recovery period. Statistical analysis included adjusting for demographic covariates including race in estimating the effect of language proficiency on these outcomes. In our cohort of 257 pediatric patients, 57 (22.2%) had low English proficiency (LEP). While LEP and English proficient (EP) patients received the same amount of opioid medication intraoperatively, in multivariable analysis, LEP patients had more than double the odds of receiving any opioid in the PACU (OR 2.45, 95% CI 1.22-4.92). LEP patients received more oral morphine equivalents (OME) than EP patients (1.64 OME/kg, CI 0.67-3.84), and they also had almost double the odds of having no pain score recorded during their PACU recovery period (OR 1.93, CI 0.79-4.73), although the precision of these estimates was limited by small sample size. Subgroup analysis showed that children over the age of 5 years, who were presumably more verbal and would therefore undergo verbal pain assessments, had over triple the odds of having no recorded pain score (OR 3.23, CI 1.48-7.06). In summary, English language proficiency may affect the management of children's pain in the perioperative setting. The etiology of this language-related disparity is likely multifactorial and should be investigated further.

Project description:BackgroundThe impact of routine preoperative anesthesia evaluations on potential perioperative complications remains unclear. This study aimed to investigate the effect of preoperative evaluation on early perioperative hemodynamic and respiratory complications.MethodsThis prospective observational study analyzed data from patients aged 18 to 80 who underwent elective surgery between October 15, 2023, and February 15, 2024. The study evaluated the effect of preoperative anesthesia evaluation on hemodynamic and respiratory complications occurring during surgery and within the first 24 h postoperatively, as well as its impact on the length of hospital stay.ResultsThe analysis included 1117 patients for whom complete data was available. Hemodynamic and respiratory complications were observed in 545 patients (48.7%), occurring within the first 24 h intraoperatively and postoperatively. Because no additional examinations beyond routine blood tests, radiological imaging, and electrocardiograms were performed in the preoperative period, the impact of these tests on the development of hemodynamic and respiratory complications could not be determined. There was no statistically significant association between the presence or absence of preoperative consultation and the occurrence of early perioperative hemodynamic and respiratory complications [OR (95% CI): 0.879 (0.646-1.195); P = 0.411], nor did it affect the length of hospital stay [median (IQR); 2 (3) vs. 2 (3); P = 0.245].ConclusionWhile the impact of routinely requested laboratory and imaging methods before surgery could not be assessed in this study, consultations that were requested did not affect hemodynamic and respiratory complications in the early perioperative period or on the duration of hospital stay.Trial registration numberSamsun University Samsun Training and Research Hospital, following ethics committee approval (Samsun University clinical research ethics committee (KAEK) 2.12.2023) and Clinical Trials (NCT06203171 / 04.18.2024) registration.

Dataset Information

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

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

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