Li Xiaoxiao, Lv Xueli, Jiang Zhenfei, Nie Xinrui, Wang Xinghe, Li Tong, Zhang Lianyi, Liu Su
Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China.
Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China.
Drug Des Devel Ther. 2020 Aug 27;14:3509-3518. doi: 10.2147/DDDT.S266062. eCollection 2020.
Propofol for procedural sedation and analgesia (PSA) for colonoscopy can result in a high prevalence of severe respiratory depression. Studies have shown that intravenous (IV) infusion of lidocaine can reduce propofol requirements significantly and increase the ventilatory response to carbon dioxide in humans. We tested the hypothesis that IV lidocaine could improve propofol-induced respiratory depression in obese patients during colonoscopy.
Ninety obese patients scheduled for painless colonoscopy were randomized to receive lidocaine (1.5 mg/kg, then 2 mg/kg/h, IV) or the same volume of 0.9% saline. Intraoperative sedation was provided by propofol. The primary outcome was the number of oxygen-desaturation episodes. Secondary outcomes were: the number of apnea episodes; total propofol consumption; time to the first hypoxia episode; time to consciousness loss; intraoperative hemodynamic parameters; awakening time; adverse events; duration of post-anesthesia care unit (PACU) stay; satisfaction of endoscopists and patients.
Demographic characteristics between the two groups were comparable. The number of oxygen-desaturation episodes in group L (1.49±1.12) decreased by 0.622 (=0.018) compared with that in group N (2.11±1.32), and the number of apnea episodes in group L decreased by 0.533 (<0.001). Kaplan-Meier curves showed that the median time to the first hypoxia episode was longer in group L (86.78 s) than that in group N (63.83 s) (Log rank =0.0008). The total propofol consumption, awakening time, and duration of PACU stay were reduced in group L. There was no significant difference in the prevalence of adverse events (>0.05 for all). Satisfaction scores for endoscopists and patients in group L were higher than that in group N (<0.001).
Intravenous infusion of lidocaine could significantly reduce the number of oxygen-desaturation and apnea episodes in obese patients during painless colonoscopy. This method is worthy of clinical promotion.
ChiCTR2000028937.
丙泊酚用于结肠镜检查的程序镇静和镇痛（PSA）可导致严重呼吸抑制的高发生率。研究表明，静脉输注利多卡因可显著降低丙泊酚需求量，并增强人体对二氧化碳的通气反应。我们检验了静脉注射利多卡因可改善肥胖患者结肠镜检查期间丙泊酚引起的呼吸抑制这一假设。
90例计划进行无痛结肠镜检查的肥胖患者被随机分为两组，分别接受利多卡因（1.5mg/kg，然后2mg/kg/h，静脉注射）或相同体积的0.9%生理盐水。术中镇静采用丙泊酚。主要结局指标为氧饱和度下降事件的数量。次要结局指标包括：呼吸暂停事件的数量；丙泊酚总用量；首次出现低氧事件的时间；意识丧失时间；术中血流动力学参数；苏醒时间；不良事件；麻醉后监护病房（PACU）停留时间；内镜医师和患者的满意度。
两组间人口统计学特征具有可比性。利多卡因组（L组）氧饱和度下降事件的数量（1.49±1.12）与生理盐水组（N组）（2.11±1.32）相比减少了0.622（P=0.018），L组呼吸暂停事件的数量减少了0.533（P<0.001）。Kaplan-Meier曲线显示，L组首次出现低氧事件的中位时间（86.78秒）长于N组（63.83秒）（对数秩检验P=0.0008）。L组丙泊酚总用量、苏醒时间和PACU停留时间均减少。不良事件发生率无显著差异（所有P>0.05）。L组内镜医师和患者的满意度评分高于N组（P<0.001）。
静脉输注利多卡因可显著减少肥胖患者无痛结肠镜检查期间氧饱和度下降和呼吸暂停事件的数量。该方法值得临床推广。
ChiCTR2000028937
