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Randomized, double-blinded, placebo controlled study of neuroprotection with lidocaine in cardiac surgery.

Publication ,  Journal Article
Mathew, JP; Mackensen, GB; Phillips-Bute, B; Grocott, HP; Glower, DD; Laskowitz, DT; Blumenthal, JA; Newman, MF ...
Published in: Stroke
March 2009

BACKGROUND AND PURPOSE: Cognitive decline after cardiac surgery remains common and diminishes patients' quality of life. Based on experimental and clinical evidence, this study assessed the potential of intravenously administered lidocaine to reduce postoperative cognitive dysfunction after cardiac surgery using cardiopulmonary bypass. METHODS: After IRB approval, 277 patients undergoing cardiac surgery were enrolled into this prospective, randomized, double-blinded placebo controlled clinical trial. Subjects were randomized to receive: (1) Lidocaine as a 1 mg/kg bolus followed by a continuous infusion through 48 hours postoperatively, or (2) Placebo bolus and infusion. Cognitive function was assessed preoperatively and again at 6 weeks and 1 year postoperatively. The effect of lidocaine on postoperative cognition was tested using multivariable regression modeling; P<0.05 was considered significant. RESULTS: Among the 241 allocated subjects (Lidocaine: n=114; Placebo: n=127), the incidence of cognitive deficit in the lidocaine group was 45.5% versus 45.7% in the placebo group (P=0.97). Multivariable analysis revealed a significant interaction between treatment group and diabetes, such that diabetic subjects receiving lidocaine were more likely to suffer cognitive decline (P=0.004). Secondary analysis identified total lidocaine dose (mg/kg) as a significant predictor of cognitive decline and also revealed a protective effect of lower dose lidocaine in nondiabetic subjects. CONCLUSIONS: Lidocaine administered during and after cardiac surgery does not reduce the high rate of postoperative cognitive dysfunction. Higher doses of lidocaine and diabetic status were independent predictors of cognitive decline. Protective effects of lower dose lidocaine in nondiabetic subjects need to be further evaluated.

Duke Scholars

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

March 2009

Volume

40

Issue

3

Start / End Page

880 / 887

Location

United States

Related Subject Headings

  • Regression Analysis
  • Psychomotor Performance
  • Postoperative Complications
  • Neuropsychological Tests
  • Neuroprotective Agents
  • Neurology & Neurosurgery
  • Middle Aged
  • Memory
  • Male
  • Lidocaine
 

Citation

APA
Chicago
ICMJE
MLA
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Mathew, J. P., Mackensen, G. B., Phillips-Bute, B., Grocott, H. P., Glower, D. D., Laskowitz, D. T., … Neurologic Outcome Research Group (NORG) of the Duke Heart Center, . (2009). Randomized, double-blinded, placebo controlled study of neuroprotection with lidocaine in cardiac surgery. Stroke, 40(3), 880–887. https://doi.org/10.1161/STROKEAHA.108.531236
Mathew, Joseph P., G Burkhard Mackensen, Barbara Phillips-Bute, Hilary P. Grocott, Donald D. Glower, Daniel T. Laskowitz, James A. Blumenthal, Mark F. Newman, and Mark F. Neurologic Outcome Research Group (NORG) of the Duke Heart Center. “Randomized, double-blinded, placebo controlled study of neuroprotection with lidocaine in cardiac surgery.Stroke 40, no. 3 (March 2009): 880–87. https://doi.org/10.1161/STROKEAHA.108.531236.
Mathew JP, Mackensen GB, Phillips-Bute B, Grocott HP, Glower DD, Laskowitz DT, et al. Randomized, double-blinded, placebo controlled study of neuroprotection with lidocaine in cardiac surgery. Stroke. 2009 Mar;40(3):880–7.
Mathew, Joseph P., et al. “Randomized, double-blinded, placebo controlled study of neuroprotection with lidocaine in cardiac surgery.Stroke, vol. 40, no. 3, Mar. 2009, pp. 880–87. Pubmed, doi:10.1161/STROKEAHA.108.531236.
Mathew JP, Mackensen GB, Phillips-Bute B, Grocott HP, Glower DD, Laskowitz DT, Blumenthal JA, Newman MF, Neurologic Outcome Research Group (NORG) of the Duke Heart Center. Randomized, double-blinded, placebo controlled study of neuroprotection with lidocaine in cardiac surgery. Stroke. 2009 Mar;40(3):880–887.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

March 2009

Volume

40

Issue

3

Start / End Page

880 / 887

Location

United States

Related Subject Headings

  • Regression Analysis
  • Psychomotor Performance
  • Postoperative Complications
  • Neuropsychological Tests
  • Neuroprotective Agents
  • Neurology & Neurosurgery
  • Middle Aged
  • Memory
  • Male
  • Lidocaine