Department of Anesthesiology, The Affiliated Huaian Hospital of Xuzhou Medical University and Huaian Second People's Hospital, Huaian, Jiangsu, China (mainland).
Department of Ear, Nose and Throat, The Affiliated Huaian Hospital of Xuzhou Medical University and Huaian Second People's Hospital, Huaian, Jiangsu, China (mainland).
Med Sci Monit. 2021 Feb 2;27:e926990. doi: 10.12659/MSM.926990.
Obstructive sleep apnea (OSA) is defined by intermittent and recurrent episodes of partial or complete obstruction of the upper airway during sleep. Intermittent and recurrent hypoxia/reoxygenation is the main pathophysiological mechanism of OSA. Its consequences include systemic inflammation, activation of the sympathetic nervous system, and release of oxygen free radicals. Infusion of intravenous (IV) lidocaine has anti-inflammatory, antihyperalgesic, and analgesic properties, supporting its use as an anesthetic adjuvant. Lidocaine can reduce nociception and/or cardiovascular responses to surgical stress, as well as postoperative pain and/or analgesic requirements. Because of the high prevalence of OSA in obese patients, the use of opioids to manage postoperative pain in that population is often accompanied by the development of adverse respiratory events, such as hypoventilation and hypoxemia. IV infusion of lidocaine has been shown to enhance the quality of early recovery after laparoscopic bariatric and upper airway surgery. However, limited evidence exists regarding its use in patients undergoing surgery for OSA. In addition, whether IV infusion of lidocaine can improve postoperative early recovery in patients undergoing surgery for OSA remains unknown. Therefore, we hypothesized that IV infusion of lidocaine can improve postoperative early recovery in patients undergoing surgery for OSA. Perioperative infusion also may be a promising analgesic adjunct to enhanced recovery after surgery (ERAS) protocols.
阻塞性睡眠呼吸暂停（OSA）是指睡眠期间上气道部分或完全阻塞的间歇性和复发性发作。间歇性和复发性低氧/再氧合是 OSA 的主要病理生理机制。其后果包括全身炎症、交感神经系统激活和氧自由基释放。静脉（IV）利多卡因输注具有抗炎、抗痛觉过敏和镇痛作用，支持其作为麻醉辅助剂的使用。利多卡因可以减少手术应激引起的伤害性感受和/或心血管反应，以及术后疼痛和/或镇痛需求。由于肥胖患者中 OSA 的高发率，在该人群中使用阿片类药物来管理术后疼痛通常会伴有不良的呼吸事件，如通气不足和低氧血症。静脉输注利多卡因已被证明可提高腹腔镜减重和上气道手术后的早期恢复质量。然而，关于其在 OSA 手术患者中的应用的证据有限。此外，静脉输注利多卡因是否可以改善 OSA 手术患者的术后早期恢复仍不清楚。因此，我们假设静脉输注利多卡因可以改善 OSA 手术患者的术后早期恢复。围手术期输注也可能是增强术后恢复（ERAS）方案的有前途的镇痛辅助剂。
