Qin Junjun, He Changlin, Chen Zhengwei, Yan Sijun, Ma Jiasen
Department of Anesthesiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China.
National Clinical Center for Child Health, Hangzhou, Zhejiang, China.
Indian J Anaesth. 2025 Aug;69(8):748-758. doi: 10.4103/ija.ija_201_25. Epub 2025 Jul 10.
Haemodynamic fluctuations during laryngoscopy and tracheal intubation remain a key concern in anaesthetic practice, with cardiovascular stress responses posing risks of serious complications. This meta-analysis aims to assess the benefits and risks of pre-intubation intravenous (IV) lignocaine, focusing on enhancing haemodynamic stability and developing evidence-based dosing guidelines.
Searches were performed in PubMed, Embase, the Cochrane Library, Web of Science, ClinicalTrials.gov, and key references up to 16 February 2025 to identify randomised controlled trials (RCTs) comparing adult patients who received or did not receive IV lignocaine prior to tracheal intubation. Data from eligible studies were pooled to calculate the combined risk ratio (RR) or mean difference (MD).
Eighteen studies (1056 participants) were included. A single IV injection of lignocaine at 40 mg fixed-dose and 0.5-2 mg/kg was studied for preventing haemodynamic fluctuations induced by laryngoscopy and tracheal intubation. Relative to non-lignocaine, IV lignocaine suppressed the increases in mean arterial pressure (MAP) [MD: -3.85; 95% confidence interval (CI): -6.61, -1.09; = 0.006; 84%] and heart rate (HR) (MD: -4.72; 95% CI: -7.55, -1.90; = 0.001; 86%) caused by laryngoscopy and tracheal intubation. The lignocaine group had fewer complications compared with the non-lignocaine group.
IV lignocaine 1-2 mg/kg can effectively suppress the increase in MAP caused by laryngoscopy and tracheal intubation. However, the effectiveness of lignocaine regarding HR seems to require optimisation based on both dosage and ethnicity.
喉镜检查和气管插管期间的血流动力学波动仍是麻醉实践中的关键问题，心血管应激反应会带来严重并发症的风险。本荟萃分析旨在评估插管前静脉注射利多卡因的益处和风险，重点是增强血流动力学稳定性并制定基于证据的给药指南。
在PubMed、Embase、Cochrane图书馆、科学网、ClinicalTrials.gov以及截至2025年2月16日的关键参考文献中进行检索，以确定比较气管插管前接受或未接受静脉注射利多卡因的成年患者的随机对照试验（RCT）。汇总符合条件研究的数据以计算合并风险比（RR）或平均差（MD）。
纳入了18项研究（1056名参与者）。研究了单次静脉注射40mg固定剂量和0.5 - 2mg/kg的利多卡因预防喉镜检查和气管插管引起的血流动力学波动。相对于未使用利多卡因，静脉注射利多卡因可抑制喉镜检查和气管插管引起的平均动脉压（MAP）升高[MD：-3.85；95%置信区间（CI）：-6.61，-1.09；P = 0.006；I² = 84%]和心率（HR）升高（MD：-4.72；95%CI：-7.55，-1.90；P = 0.001；I² = 86%）。利多卡因组的并发症比未使用利多卡因组少。
静脉注射1 - 2mg/kg利多卡因可有效抑制喉镜检查和气管插管引起的MAP升高。然而，利多卡因对HR的有效性似乎需要根据剂量和种族进行优化。
