Anesthesia and Pain Management (1)
Anesthesia and Sedative Agents (1)
RNA modifications and cancer (1)
Dental Anxiety and Anesthesia Techniques (1)
Anesthesia and Neurotoxicity Research (1)
Recent literatures have shown that lidocaine obviously shortened the onset time and reduced the maintenance dose of vecuronium. However, there have been no reports on the use of mivacurium. This study aimed to investigate the effects of lidocaine on the requirement and onset time of mivacurium administration during gynecological laparoscopic surgery. 66 patients scheduled for elective gynecological laparoscopic surgery were randomly assigned to receive an intravenous bolus of 1.5 mg·kg lidocaine followed by a continuous infusion of 2 mg·kg·h or an equivalent volume of placebo. Neuromuscular block was induced with 0.2 mg·kg followed by an infusion of 0.2 mg·kg·h mivacurium. The primary outcome was the onset time of mivacurium. Consumption of mivacurium, extubation time, and postoperative numeric rating scale (NRS) score for pain were recorded. The onset time of mivacurium was significantly shorter in the lidocaine group than in the control group (mean difference -25.0 s, 95% CI -47.8 to -2.3, =0.032). Hourly consumption of mivacurium was lower in the lidocaine group than in the control group (median difference, -0.04 mg·kg·h; 95% CI, -0.08 to -0.01; =0.017). The extubation time was also significantly shorter in the lidocaine group than in the control group (=0.006). The NRS pain score at 6 h and 12 h after surgery was lower in the lidocaine group than in the control group. Intravenously administered lidocaine significantly decreased the requirement of mivacurium, shortened the onset time, accelerated the extubation time, and alleviated pain intensity at 6 h and 12 h after surgery, without increasing adverse events in patients with a low risk of airway difficulty undergoing gynecological laparoscopic surgery. Given the small sample size from a single centre, our result requires further verification.
Febrile infection-related epilepsy syndrome (FIRES) is a catastrophic, drug-resistant epileptic encephalopathy characterized by acute onset following febrile illness and progression to (super-)refractory status epilepticus. We report a case of FIRES in a previously healthy 5-year-and-11-month-old boy who developed super-refractory status epilepticus (SRSE) on day 6 of a nonspecific febrile illness. The seizures were characterized by upward eye deviation, generalized tonic posturing, perioral cyanosis, and persistent impairment of consciousness. Despite comprehensive treatments including multiple immunotherapies (intravenous immunoglobulin administration, methylprednisolone pulse therapy, tocilizumab, and anakinra), ketogenic diet, multiple anti-seizure medications, and management of complications (intracranial pressure control, anti-infective therapy, and respiratory support), seizures remained refractory. Due to refractory seizures, intravenous lidocaine (3 mg/kg/h) was initiated after failed trials of midazolam, propofol and chloral hydrate, and only partial response to ketamine. With a consecutive 35-day infusion (cumulative duration >45 days), this regimen produced substantial reductions in both seizure frequency and severity, with clinically significant improvement in seizure control. Electroencephalogram (EEG) monitoring showed a decrease in the frequency and intensity of epileptic discharges, and improved background activity. The patient's level of consciousness also showed signs of improvement. This case is notable as few reports exist on the use of lidocaine in FIRES patients. It highlights the potential of lidocaine as a valuable anti-seizure option in FIRES management, suggesting the need for further investigation into its safety, efficacy, optimal dosage, and treatment duration in a larger cohort of FIRES patients.
Many clinical trials have demonstrated the benefits of intraoperative systemic lidocaine administration in major abdominal surgeries. We tested the hypothesis that systemic lidocaine is associated with an enhanced early quality of recovery in patients following laparoscopic colorectal resection. We randomly allocated 126 patients scheduled for laparoscopic colorectal surgery in a 1:1 ratio to receive either lidocaine (1.5 mg kg bolus over 10 min, followed by continuous infusion at 2 mg kg h until the end of surgery) or identical volumes and rates of saline. The primary outcome was the Quality of Recovery-15 score assessed 24 h after surgery. Secondary outcomes were areas under the pain numeric rating scale curve over time, 48-h morphine consumption, and adverse events. Compared with saline, systemic lidocaine improved the Quality of Recovery-15 score 24 h postoperatively, with a median difference of 4 (95% confidence interval: 1-6; = 0.015). Similarly, the area under the pain numeric rating scale curve over 48 h at rest and on movement was reduced in the lidocaine group ( = 0.004 and < 0.001, respectively). However, these differences were not clinically meaningful. Lidocaine infusion reduced the intraoperative remifentanil requirements but not postoperative 48-h morphine consumption ( < 0.001 and = 0.34, respectively). Additionally, patients receiving lidocaine had a quicker and earlier return of bowel function, as indicated by a shorter time to first flatus (log-rank < 0.001), yet ambulation time was similar between groups (log-rank test, = 0.11). In patients undergoing laparoscopic colorectal surgery, intraoperative systemic lidocaine resulted in statistically but not clinically significant improvements in quality of recovery (see Graphical Abstract). Chinese Clinical Trial Registry; ChiCTR1900027635.