静脉注射利多卡因 50%有效剂量抑制儿童舒芬太尼诱导咳嗽的随机对照试验。

50% efficacy dose of intravenous lidocaine in supressing sufentanil-induced cough in children: a randomised controlled trial.

机构信息

Institute of Anesthesiology and Critical Care Medicine, Three Gorges University & Yichang Central People's Hospital, Yichang City, Hubei Province, 443000, China.

出版信息

BMC Anesthesiol. 2024 Apr 19;24(1):149. doi: 10.1186/s12871-024-02541-6.

DOI:10.1186/s12871-024-02541-6

PMID:38641778

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11027416/

Abstract

BACKGROUND

Opioids such as sufentanil are used as anaesthetics due to their rapid action and superior analgesic effect. However, sufentanil induces a huge cough in paediatric patients. In contrast, intravenous (IV) lidocaine suppresses opioid-induced cough in children, but its use is limited due to anaesthetists' concern about its toxicity. Therefore, this study aimed to evaluate the effect of dose-dependent IV lidocaine on sufentanil-induced cough (SIC) in paediatric patients.

METHODS

A total of 188 patients aged 3-12 years scheduled for elective tonsillectomy with or without adenoidectomy were enrolled and divided into four groups depending on different dose of lidocaine: A (0 mg.kg-1), B (1 mg.kg-1), C (1.5 mg.kg-1), and D (2 mg.kg-1). The primary outcome was the SIC grade observed during the induction of general anaesthesia. The secondary outcomes were the incidence of SIC, mean arterial pressure, and heart rate at T0, T1, T2, T3, T4, and T5.

RESULTS

The SIC grade was significantly different between groups A and D (P = 0.04) and between groups B and D (P = 0.03). Moreover, the incidence of SIC in groups A, B, C, and D was 81%, 87%, 68%, and 64%, respectively, and the difference between groups B and C (P = 0.03) and between groups B and D (P = 0.0083) was statistically significant. No statistical differences were observed in the hemodynamic parameters between the groups. The incidence of severe cough was statistically different between group D and group A (P < 0.0001), between group D and group B (P < 0.0001), and between group D and group C (P < 0.0001) respectively.

CONCLUSIONS

Lidocaine suppresses SIC in a dose-dependent manner without severe adverse events. IV lidocaine can be used in paediatric patients safely and efficiently, and the median effective dose was 1.75 mg/kg.

TRIAL REGISTRATION

This study was approved by the Institutional Review Board of Yichang Central People's Hospital (HEC-KYJJ-2020-038-02), The trial was registered at www.chictr.org.cn (ChiCTR2100053006).

摘要

背景

舒芬太尼等阿片类药物由于起效迅速、镇痛效果好而被用作麻醉剂。然而，舒芬太尼会引起小儿剧烈咳嗽。相比之下，静脉注射（IV）利多卡因可抑制儿童阿片类药物引起的咳嗽，但由于麻醉师担心其毒性，其使用受到限制。因此，本研究旨在评估剂量依赖性 IV 利多卡因对小儿舒芬太尼诱导咳嗽（SIC）的影响。

方法

共纳入 188 名年龄 3-12 岁的择期行扁桃体切除术加或不加腺样体切除术的患者，根据利多卡因的不同剂量分为四组：A 组（0mg/kg-1）、B 组（1mg/kg-1）、C 组（1.5mg/kg-1）和 D 组（2mg/kg-1）。主要结局为观察全身麻醉诱导期间 SIC 的等级。次要结局为 T0、T1、T2、T3、T4 和 T5 时的 SIC 发生率、平均动脉压和心率。

结果

组 A 和 D（P=0.04）以及组 B 和 D（P=0.03）之间的 SIC 等级差异有统计学意义。此外，组 A、B、C 和 D 的 SIC 发生率分别为 81%、87%、68%和 64%，组 B 和 C（P=0.03）以及组 B 和 D（P=0.0083）之间的差异有统计学意义。各组间血流动力学参数无统计学差异。组 D 与组 A（P<0.0001）、组 D 与组 B（P<0.0001）和组 D 与组 C（P<0.0001）之间的严重咳嗽发生率差异有统计学意义。