Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery: A Randomized Controlled Trial.
Journal Article (Journal Article;Multicenter Study)
BACKGROUND: Cognitive decline after cardiac surgery occurs frequently and persists in a significant proportion of patients. Preclinical studies and human trials suggest that intravenous lidocaine may confer protection in the setting of neurologic injury. It was hypothesized that lidocaine administration would reduce cognitive decline after cardiac surgery compared to placebo. METHODS: After institutional review board approval, 478 patients undergoing cardiac surgery were enrolled into this multicenter, prospective, randomized, double-blinded, placebo-controlled, parallel group trial. Subjects were randomized to lidocaine 1 mg/kg bolus after the induction of anesthesia followed by a continuous infusion (48 μg · kg · min for the first hour, 24 μg · kg · min for the second hour, and 10 μg · kg · min for the next 46 h) or saline with identical volume and rate changes to preserve blinding. Cognitive function was assessed preoperatively and at 6 weeks and 1 yr postoperatively using a standard neurocognitive test battery. The primary outcome was change in cognitive function between baseline and 6 weeks postoperatively, adjusting for age, years of education, baseline cognition, race, and procedure type. RESULTS: Among the 420 allocated subjects who returned for 6-week follow-up (lidocaine: N = 211; placebo: N = 209), there was no difference in the continuous cognitive score change (adjusted mean difference [95% CI], 0.02 (-0.05, 0.08); P = 0.626). Cognitive deficit (greater than 1 SD decline in at least one cognitive domain) at 6 weeks occurred in 41% (87 of 211) in the lidocaine group versus 40% (83 of 209) in the placebo group (adjusted odds ratio [95% CI], 0.94 [0.63, 1.41]; P = 0.766). There were no differences in any quality of life outcomes between treatment groups. At the 1-yr follow-up, there continued to be no difference in cognitive score change, cognitive deficit, or quality of life. CONCLUSIONS: Intravenous lidocaine administered during and after cardiac surgery did not reduce postoperative cognitive decline at 6 weeks.
Full Text
Duke Authors
- Babyak, Michael Alan
- Bennett, Ellen Ruth
- Berger, Miles
- Blumenthal, James Alan
- Browndyke, Jeffrey Nicholas
- D'Amico, Thomas Anthony
- Gaca, Jeffrey Giles
- Glower Jr., Donald D.
- Graffagnino, Carmelo
- Harpole Jr., David Harold
- Hartwig, Matthew
- Hughes IV, George Charles
- Karhausen, Jorn
- Klapper, Jacob A
- Klinger, Rebecca Yasmin
- Krishnamoorthy, Vijay
- Laskowitz, Daniel Todd
- Li, Yi-Ju
- Lin, Shu Shiuh-Shi
- Mathew, Joseph P.
- Milano, Carmelo Alessio
- Newman, Mark Franklin
- Plichta, Ryan P
- Podgoreanu, Mihai V.
- Sketch Jr., Michael Hugh
- Smith, Peter Kent
- Stafford-Smith, Mark
- Swaminathan, Madhav
- Terrando, Niccolò
- Tong, Betty Caroline
- Welsh-Bohmer, Kathleen Anne
Cited Authors
- Klinger, RY; Cooter, M; Bisanar, T; Terrando, N; Berger, M; Podgoreanu, MV; Stafford-Smith, M; Newman, MF; Mathew, JP; Neurologic Outcomes Research Group of the Duke Heart Center,
Published Date
- June 2019
Published In
Volume / Issue
- 130 / 6
Start / End Page
- 958 - 970
PubMed ID
- 30870159
Pubmed Central ID
- PMC6520120
Electronic International Standard Serial Number (EISSN)
- 1528-1175
Digital Object Identifier (DOI)
- 10.1097/ALN.0000000000002668
Language
- eng
Conference Location
- United States