Anesthesia and Pain Management (9)
Nausea and vomiting management (7)
Anesthesia and Sedative Agents (6)
Conducting polymers and applications (4)
Neuroscience and Neural Engineering (4)
A combination of dexamethasone, ondansetron, and total intravenous anaesthesia (TIVA) is recommended as prophylaxis for preventing postoperative vomiting (POV) in high-risk children. Implementing TIVA in paediatric patients undergoing anaesthesia presents challenges due to its excessive inter-individual variability and difficult estimation. Regarding lidocaine's antiemetic effect in paediatric patients, incorporating lidocaine can mitigate POV in high-risk children. Among 204 children undergoing elective tonsillectomy (with/without adenoidectomy), those with postoperative vomiting score ≥ 4 was randomised into Group C (saline) and Group L (lidocaine). The primary outcome was POV incidence within the first 24 h after surgery. The POV incidence differed among 15 patients in Group C (14.7%) and 5 in Group L (4.9%) presenting with one or more episodes of POV (P = 0.019). The secondary outcome was the number of coughs within the first 30 min after surgery. The number of coughs within the first 30 min after surgery significantly differed between Group L (0 [0-0.125]) and Group C (1 [0-2]) (P = 0.007). Significant between-group differences in the time to extubation were also observed, with a 3-min longer time in Group L. A lower percentage of patients experienced adverse events in Group C (2.2%) compared with Group L (1.1%) (P = 0.567); no severe events occurred. Adding intravenous lidocaine to ondansetron and dexamethasone was effective in reducing the POV incidence and extubation coughs in high-risk children following volatile anaesthesia for tonsillectomy.
The dose-response of intravenous lidocaine in preventing postoperative vomiting (POV) in children remains unclear. This study investigated whether intravenous lidocaine dose-dependently decreased POV risk within 24 h postoperatively in children undergoing tonsillectomy (with or without adenoidectomy) without severe complications. Patients aged 3-12 years (American Society of Anesthesiologists grade I-II) scheduled for elective tonsillectomy (with or without adenoidectomy) were enroled from December 2021 to March 2022. They were randomly grouped according to the lidocaine dose (A [0 mg kg], B [1 mg kg], C [1.5 mg kg], and D [2 mg kg]) and were administered the same induction protocol (sufentanil, propofol, and suxamethonium chloride). Anaesthesia was maintained with sevoflurane. The incidence of POV within 24 h postoperatively was 46, 40, 36, and 20% in groups A, B, C, and D, respectively, with significant differences between groups D and A. Postoperative analgesic rescues in groups A, B, C, and D were 62, 36, 34, and 16%, respectively, with significant differences between groups D and B, C and A, and D and A. No severe adverse events were reported. Intravenous lidocaine has a dose-dependent effect on reducing the risk of POV in children undergoing tonsillectomy (with or without adenoidectomy) without serious adverse events.Trial registration: Chinese Clinical Trial Registry, ChiCTR2100053006.
Postoperative cognitive dysfunction (POCD) has been reported as a significant complication in elderly patients. Various methods have been proposed for reducing the incidence and severity of POCD. Intravenous lidocaine administration has been reported in the literature to reduce POCD, but the effect of lidocaine remains controversial. We screened Medline, Embase, Cochrane Library, and China National Knowledge Infrastructure (up to April 2022) databases following a search strategy for intravenous lidocaine on POCD. We also screened related bibliographies on lidocaine for POCD. Ten articles comprising 1517 patients were selected and analyzed. We divided the postoperative follow-up period as follows: short term (<30 days), medium term (30-90 days), and long term (>90 days). We found that lidocaine could attenuate the overall incidence of POCD, especially in the short term. There were no differences between lidocaine and placebo on the overall severity of POCD. Lidocaine administered intravenously could attenuate the overall incidence of POCD and its severity in the short term.