Department of Anesthesiology, Centre Hospitalier Universitaire Grenoble-Alpes, Boulevard de la Chantourne, 38700, Grenoble, France.
Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
BMC Anesthesiol. 2020 Jun 23;20(1):155. doi: 10.1186/s12871-020-01075-x.
Major abdominal surgery is associated with endothelial glycocalyx disruption. The anti-inflammatory effects of lidocaine were recently associated with endothelial barrier protection.
This was a single-centre, parallel group, randomized, controlled, double blind, pilot trial. Forty adult patients scheduled for major abdominal surgery were included between December 2016 and March 2017 in the setting of a University Hospital in Brussels (Belgium); reasons for non-inclusion were planned liver resection and conditions associated to increased risk of local anesthetics systemic toxicity. Patients were randomized to receive either lidocaine by continuous intravenous administration or an equivalent volume of 0.9% saline. The primary endpoint was the postoperative syndecan-1 concentration (difference between groups). Near-infrared spectroscopy of the thenar eminence in association with the vascular occlusion test, and contemporary analysis of flow-mediated dilation of the brachial artery were the secondary outcomes, along with haemodynamic data. Blood samples and data were collected before surgery (T0), and at 1-3 h (T1) and 24 h (T2) post-surgery.
Syndecan-1 concentration increased significantly post-surgery (P < 0.001), but without any difference between groups. The near-infrared spectroscopy-derived and flow-mediated dilation-derived variables showed minor changes unrelated to group assignment. Compared with the placebo group, the intervention group had a significantly lower peri-operative mean arterial pressure and cardiac index, despite equally conducted goal-directed haemodynamic management. Postoperative lactate concentrations were similar between groups.
Lidocaine failed to have any effect on endothelial function. Since in comparisons to other types of clinical situations, syndecan-1 was only slightly upregulated, endothelial dysfunction after major abdominal surgery might be overestimated.
« ISRCTN Registry » identifier: ISRCTN63417725. Date: 15/06/2020. Retrospectively registered.
大腹部手术与内皮糖萼层破坏有关。利多卡因的抗炎作用最近与内皮屏障保护有关。
这是一项单中心、平行组、随机、对照、双盲、初步试验。2016 年 12 月至 2017 年 3 月，比利时布鲁塞尔的一家大学医院纳入了 40 名接受大腹部手术的成年患者；未纳入的原因是计划进行肝切除术和与局部麻醉剂全身毒性风险增加相关的情况。患者被随机分配接受持续静脉内给予利多卡因或等效体积的 0.9%生理盐水。主要终点是术后硫酸乙酰肝素蛋白聚糖-1 浓度（组间差异）。大鱼际近红外光谱与血管闭塞试验以及肱动脉血流介导扩张的同期分析是次要结果，同时还有血流动力学数据。在手术前（T0）以及术后 1-3 小时（T1）和 24 小时（T2）收集血样和数据。
硫酸乙酰肝素蛋白聚糖-1 浓度在手术后显著增加（P<0.001），但组间无差异。近红外光谱衍生和血流介导扩张衍生的变量显示与组分配无关的微小变化。与安慰剂组相比，尽管进行了同等的目标导向性血流动力学管理，干预组的围手术期平均动脉压和心指数均显著降低。两组术后乳酸浓度相似。
利多卡因对内皮功能没有影响。由于与其他类型的临床情况相比，硫酸乙酰肝素蛋白聚糖-1 仅略有上调，因此大腹部手术后的内皮功能障碍可能被高估。
“ISRCTN 注册表”标识符：ISRCTN63417725。日期：2020 年 6 月 15 日。回顾性注册。
