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Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery: A Randomized Controlled Trial.

Publication ,  Journal Article
Klinger, RY; Cooter, M; Bisanar, T; Terrando, N; Berger, M; Podgoreanu, MV; Stafford-Smith, M; Newman, MF; Mathew, JP ...
Published in: Anesthesiology
June 2019

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.

Duke Scholars

Rebecca Yasmin Klinger
Author Rebecca Yasmin Klinger Anesthesiology, Cardiothoracic
Niccolò Terrando
Author Niccolò Terrando Anesthesiology
Miles Berger
Author Miles Berger Anesthesiology, Neuroanesthesia
Mihai V. Podgoreanu
Author Mihai V. Podgoreanu Anesthesiology, Cardiothoracic
Mark Stafford-Smith
Author Mark Stafford-Smith Anesthesiology, Cardiothoracic
Mark Franklin Newman
Author Mark Franklin Newman Anesthesiology, Cardiothoracic
Joseph P. Mathew
Author Joseph P. Mathew Anesthesiology, Cardiothoracic
James Alan Blumenthal
Author James Alan Blumenthal Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...
Vijay Krishnamoorthy
Author Vijay Krishnamoorthy Anesthesiology, Critical Care Medicine
Yi-Ju Li
Author Yi-Ju Li Biostatistics & Bioinformatics, Division of Integrative Geno ...
Madhav Swaminathan
Author Madhav Swaminathan Anesthesiology, Cardiothoracic
Michael Alan Babyak
Author Michael Alan Babyak Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...
Jeffrey Nicholas Browndyke
Author Jeffrey Nicholas Browndyke Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...
Kathleen Anne Welsh-Bohmer
Author Kathleen Anne Welsh-Bohmer Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...
Michael Hugh Sketch Jr.
Author Michael Hugh Sketch Jr. Medicine, Cardiology
Ellen Ruth Bennett
Author Ellen Ruth Bennett Neurology, Neurocritical Care
Carmelo Graffagnino
Author Carmelo Graffagnino Neurology, Neurocritical Care
Daniel Todd Laskowitz
Author Daniel Todd Laskowitz Neurology, Neurocritical Care
Thomas Anthony D'Amico
Author Thomas Anthony D'Amico Surgery, Cardiovascular and Thoracic Surgery
Jeffrey Giles Gaca
Author Jeffrey Giles Gaca Surgery, Cardiovascular and Thoracic Surgery
Donald D. Glower Jr.
Author Donald D. Glower Jr. Surgery, Cardiovascular and Thoracic Surgery
David Harold Harpole Jr.
Author David Harold Harpole Jr. Surgery, Cardiovascular and Thoracic Surgery
Matthew Hartwig
Author Matthew Hartwig Surgery, Cardiovascular and Thoracic Surgery
George Charles Hughes IV
Author George Charles Hughes IV Surgery, Cardiovascular and Thoracic Surgery
Jacob A Klapper
Author Jacob A Klapper Surgery, Cardiovascular and Thoracic Surgery
Shu Shiuh-Shi Lin
Author Shu Shiuh-Shi Lin Surgery, Cardiovascular and Thoracic Surgery
Carmelo Alessio Milano
Author Carmelo Alessio Milano Surgery, Cardiovascular and Thoracic Surgery
Peter Kent Smith
Author Peter Kent Smith Surgery, Cardiovascular and Thoracic Surgery
Betty Caroline Tong
Author Betty Caroline Tong Surgery, Cardiovascular and Thoracic Surgery
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Published In

Anesthesiology

DOI

EISSN

1528-1175

Publication Date

June 2019

Volume

130

Issue

6

Start / End Page

958 / 970

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Prospective Studies
  • Postoperative Cognitive Complications
  • Neurocognitive Disorders
  • Middle Aged
  • Mental Status and Dementia Tests
  • Male
  • Lidocaine
  • Humans
  • Follow-Up Studies
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Klinger, R. Y., Cooter, M., Bisanar, T., Terrando, N., Berger, M., Podgoreanu, M. V., … Neurologic Outcomes Research Group of the Duke Heart Center, . (2019). Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery: A Randomized Controlled Trial. Anesthesiology, 130(6), 958–970. https://doi.org/10.1097/ALN.0000000000002668
Klinger, Rebecca Y., Mary Cooter, Tiffany Bisanar, Niccolò Terrando, Miles Berger, Mihai V. Podgoreanu, Mark Stafford-Smith, Mark F. Newman, Joseph P. Mathew, and Joseph P. Neurologic Outcomes Research Group of the Duke Heart Center. “Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery: A Randomized Controlled Trial.Anesthesiology 130, no. 6 (June 2019): 958–70. https://doi.org/10.1097/ALN.0000000000002668.
Klinger RY, Cooter M, Bisanar T, Terrando N, Berger M, Podgoreanu MV, et al. Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery: A Randomized Controlled Trial. Anesthesiology. 2019 Jun;130(6):958–70.
Klinger, Rebecca Y., et al. “Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery: A Randomized Controlled Trial.Anesthesiology, vol. 130, no. 6, June 2019, pp. 958–70. Pubmed, doi:10.1097/ALN.0000000000002668.
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. Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery: A Randomized Controlled Trial. Anesthesiology. 2019 Jun;130(6):958–970.

Published In

Anesthesiology

DOI

EISSN

1528-1175

Publication Date

June 2019

Volume

130

Issue

6

Start / End Page

958 / 970

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Prospective Studies
  • Postoperative Cognitive Complications
  • Neurocognitive Disorders
  • Middle Aged
  • Mental Status and Dementia Tests
  • Male
  • Lidocaine
  • Humans
  • Follow-Up Studies