Hashemi Sayed Jalal, Heidari Sayed Morteza, Rahavi Azadeh
Department of Anesthesiology and Intensive Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2013 Oct 30;2:81. doi: 10.4103/2277-9175.120869. eCollection 2013.
Cognitive dysfunction after surgery is common in elderly patients. Many factors such as anesthetic drugs can cause complication in this surgery. Lidocaine is one of the drugs commonly used during anesthesia. So, we designed this study to find out cognitive effect of lidocaine in elderly patients undergoing non-cardiac surgeries.
In this double-blinded clinical trial, we enrolled 70 patients older than 65 years age undergoing urologic or orthopedic surgeries, were divided in two groups. Patients randomly received intravenous lidocaine (1.5 mg/kg) or normal saline in the same volume immediately before extubation. Mini mental state examination (MMSE) test was used to evaluate cognitive state at discharge time, 6 and 24 h after surgery.
Mean MMSE scores at the time of discharge from recovery room in lidocaine and saline groups were 22.4 ± 4.5 vs. 22.1 ± 4.4, P = 0.755, respectively. It was significantly lower than MMSE before surgery, 6 and 24 h after the operation. The mean MMSE scores and frequency distribution of intensity of cognitive impairments were not significantly different between two groups at different times.
Bolus intravenous lidocaine before extubation, did not affect cognitive states in elders undergoing non-cardiac surgery. Effect of lidocaine on cardiac surgeries is clear, but in non-cardiac surgeries, lidocaine has no clinical effects. So, more studies with different doses of lidocaine and different assessment methods are recommended.
术后认知功能障碍在老年患者中很常见。许多因素，如麻醉药物，可导致该手术出现并发症。利多卡因是麻醉期间常用的药物之一。因此，我们设计了这项研究，以了解利多卡因对接受非心脏手术的老年患者的认知影响。
在这项双盲临床试验中，我们纳入了70例年龄大于65岁接受泌尿外科或骨科手术的患者，将其分为两组。患者在拔管前即刻随机接受静脉注射利多卡因（1.5mg/kg）或相同体积的生理盐水。采用简易精神状态检查表（MMSE）测试评估出院时、术后6小时和24小时的认知状态。
利多卡因组和生理盐水组恢复室出院时的平均MMSE评分分别为22.4±4.5和22.1±4.4，P = 0.755。该评分显著低于术前、术后6小时和24小时的MMSE评分。两组在不同时间的平均MMSE评分和认知障碍强度的频率分布无显著差异。
拔管前静脉推注利多卡因，对接受非心脏手术的老年人的认知状态无影响。利多卡因对心脏手术的影响是明确的，但在非心脏手术中，利多卡因无临床效果。因此，建议采用不同剂量的利多卡因和不同评估方法进行更多研究。
