Tang Lili, Lv Wenhui, Sun Jingjing, Chen Lijian
Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
Perioper Med (Lond). 2024 Mar 5;13(1):15. doi: 10.1186/s13741-024-00370-2.
Intravenous lidocaine could be a potential alternative adjuvant to propofol-based sedation for gastroscopy in elderly patients. This study aimed to evaluate the effect of intravenous lidocaine on the median effective dose (ED50) of propofol induction dose in elderly patients undergoing painless gastroscopy.
The study included 70 patients aged ≥ 60 years undergoing painless gastroscopy with 64 randomly assigned to either group L (2% lidocaine 1.5 mg/kg, n = 31) or group N (equal volume normal saline, n = 33). All patients received propofol induction following 0.1 μg/kg intravenous sufentanil. The Dixon "up-and-down" sequential method was used, with a 1.5 mg/kg initial induction dose of propofol followed by a 0.1 mg/kg sequential variable dose. The primary endpoint was the ED50 of the propofol induction dose. The total propofol dose, recovery time, adverse events, and local anesthetic intoxication reactions were also recorded.
The ED50 of propofol induction dose was 0.670 (95% confidence interval [CI] 0.216-0.827) mg/kg in group L and 1.118 (95% CI 0.803-1.232) mg/kg in group N. There was a statistically significant difference between the two groups (p < 0.001). The incidence of hypotension and propofol injection pain were lower in group L than in group N (p < 0.05). Furthermore, the orientation recovery time in group L was shorter compared to group N (p < 0.05). None of the participants in group L observed local anesthetic intoxication reactions after receiving lidocaine.
The administration of intravenous lidocaine to elderly patients undergoing painless gastroscopy resulted in a significant 40% reduction in the ED50 of propofol induction dose, which may be related to the decreased incidence of hypotension and injection pain, as well as the improved post-gastroscopy orientation recovery.
ChiCTR, ChiCTR2200065530. Registered on 08 November 2022.
静脉注射利多卡因可能是老年患者胃镜检查中基于丙泊酚镇静的一种潜在替代辅助药物。本研究旨在评估静脉注射利多卡因对老年无痛胃镜检查患者丙泊酚诱导剂量的半数有效剂量（ED50）的影响。
本研究纳入70例年龄≥60岁的接受无痛胃镜检查的患者，其中64例随机分为L组（2%利多卡因1.5mg/kg，n = 31）或N组（等体积生理盐水，n = 33）。所有患者在静脉注射0.1μg/kg舒芬太尼后接受丙泊酚诱导。采用Dixon“上下”序贯法，丙泊酚初始诱导剂量为1.5mg/kg，随后序贯可变剂量为0.1mg/kg。主要终点是丙泊酚诱导剂量的ED50。还记录了丙泊酚总剂量、恢复时间、不良事件和局部麻醉药中毒反应。
L组丙泊酚诱导剂量的ED50为0.670（95%置信区间[CI]0.216 - 0.827）mg/kg，N组为1.118（95%CI 0.803 - 1.232）mg/kg。两组间差异有统计学意义（p < 0.001）。L组低血压和丙泊酚注射痛的发生率低于N组（p < 0.05）。此外，L组的定向恢复时间比N组短（p < 0.05）。L组患者在接受利多卡因后均未观察到局部麻醉药中毒反应。
对接受无痛胃镜检查的老年患者静脉注射利多卡因可使丙泊酚诱导剂量的ED50显著降低40%，这可能与低血压和注射痛发生率降低以及胃镜检查后定向恢复改善有关。
中国临床试验注册中心，ChiCTR2200065530。于2022年11月8日注册。
