Intravenous lidocaine to prevent endothelial dysfunction after major abdominal surgery: a randomized controlled pilot trial.
Endothelial dysfunction
Endothelial glycocalyx
Lidocaine
Major abdominal surgery
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
23 06 2020
23 06 2020
Historique:
received:
13
03
2020
accepted:
16
06
2020
entrez:
25
6
2020
pubmed:
25
6
2020
medline:
10
8
2021
Statut:
epublish
Résumé
Major abdominal surgery is associated with endothelial glycocalyx disruption. The anti-inflammatory effects of lidocaine were recently associated with endothelial barrier protection. This was a single-centre, parallel group, randomized, controlled, double blind, pilot trial. Forty adult patients scheduled for major abdominal surgery were included between December 2016 and March 2017 in the setting of a University Hospital in Brussels (Belgium); reasons for non-inclusion were planned liver resection and conditions associated to increased risk of local anesthetics systemic toxicity. Patients were randomized to receive either lidocaine by continuous intravenous administration or an equivalent volume of 0.9% saline. The primary endpoint was the postoperative syndecan-1 concentration (difference between groups). Near-infrared spectroscopy of the thenar eminence in association with the vascular occlusion test, and contemporary analysis of flow-mediated dilation of the brachial artery were the secondary outcomes, along with haemodynamic data. Blood samples and data were collected before surgery (T0), and at 1-3 h (T1) and 24 h (T2) post-surgery. Syndecan-1 concentration increased significantly post-surgery (P < 0.001), but without any difference between groups. The near-infrared spectroscopy-derived and flow-mediated dilation-derived variables showed minor changes unrelated to group assignment. Compared with the placebo group, the intervention group had a significantly lower peri-operative mean arterial pressure and cardiac index, despite equally conducted goal-directed haemodynamic management. Postoperative lactate concentrations were similar between groups. Lidocaine failed to have any effect on endothelial function. Since in comparisons to other types of clinical situations, syndecan-1 was only slightly upregulated, endothelial dysfunction after major abdominal surgery might be overestimated. « ISRCTN Registry » identifier: ISRCTN63417725. Date: 15/06/2020. Retrospectively registered.
Sections du résumé
BACKGROUND
Major abdominal surgery is associated with endothelial glycocalyx disruption. The anti-inflammatory effects of lidocaine were recently associated with endothelial barrier protection.
METHODS
This was a single-centre, parallel group, randomized, controlled, double blind, pilot trial. Forty adult patients scheduled for major abdominal surgery were included between December 2016 and March 2017 in the setting of a University Hospital in Brussels (Belgium); reasons for non-inclusion were planned liver resection and conditions associated to increased risk of local anesthetics systemic toxicity. Patients were randomized to receive either lidocaine by continuous intravenous administration or an equivalent volume of 0.9% saline. The primary endpoint was the postoperative syndecan-1 concentration (difference between groups). Near-infrared spectroscopy of the thenar eminence in association with the vascular occlusion test, and contemporary analysis of flow-mediated dilation of the brachial artery were the secondary outcomes, along with haemodynamic data. Blood samples and data were collected before surgery (T0), and at 1-3 h (T1) and 24 h (T2) post-surgery.
RESULTS
Syndecan-1 concentration increased significantly post-surgery (P < 0.001), but without any difference between groups. The near-infrared spectroscopy-derived and flow-mediated dilation-derived variables showed minor changes unrelated to group assignment. Compared with the placebo group, the intervention group had a significantly lower peri-operative mean arterial pressure and cardiac index, despite equally conducted goal-directed haemodynamic management. Postoperative lactate concentrations were similar between groups.
CONCLUSIONS
Lidocaine failed to have any effect on endothelial function. Since in comparisons to other types of clinical situations, syndecan-1 was only slightly upregulated, endothelial dysfunction after major abdominal surgery might be overestimated.
TRIAL REGISTRATION
« ISRCTN Registry » identifier: ISRCTN63417725. Date: 15/06/2020. Retrospectively registered.
Identifiants
pubmed: 32576151
doi: 10.1186/s12871-020-01075-x
pii: 10.1186/s12871-020-01075-x
pmc: PMC7310453
doi:
Substances chimiques
SDC1 protein, human
0
Syndecan-1
0
Lidocaine
98PI200987
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
155Subventions
Organisme : Conseil Médical Hopital Erasme
ID : 22-12-2016
Pays : International
Références
Respir Res. 2016 May 17;17(1):59
pubmed: 27188409
PLoS One. 2015 Jan 09;10(1):e0117133
pubmed: 25575016
Anesthesiology. 2007 Nov;107(5):776-84
pubmed: 18073553
Crit Care Med. 2014 Dec;42(12):e741-51
pubmed: 25402295
J Surg Res. 2011 Jan;165(1):136-41
pubmed: 19560161
J Crit Care. 2016 Feb;31(1):264-8
pubmed: 26603534
Anesthesiology. 2014 Jun;120(6):1414-28
pubmed: 24525631
Cardiovasc Res. 2010 Jul 15;87(2):300-10
pubmed: 20462866
J Pain Res. 2017 Oct 31;10:2515-2524
pubmed: 29184436
Intensive Care Med. 2007 Sep;33(9):1549-56
pubmed: 17572876
Anesthesiology. 2006 May;104(5):961-9
pubmed: 16645448
Ann Intensive Care. 2011 Jul 19;1(1):27
pubmed: 21906380
Perfusion. 2008 May;23(3):165-71
pubmed: 19029267
Ultrasound Med Biol. 2008 Mar;34(3):385-91
pubmed: 17964069
Br J Anaesth. 2017 Feb;118(2):200-206
pubmed: 28100523
Anesthesiology. 2011 Sep;115(3):483-91
pubmed: 21785339
J Am Coll Cardiol. 2002 Jan 16;39(2):257-65
pubmed: 11788217
J Cardiothorac Vasc Anesth. 2015 Aug;29(4):912-6
pubmed: 25661644
J Transl Med. 2015 Apr 12;13:117
pubmed: 25889764
Resuscitation. 2012 Jun;83(6):715-20
pubmed: 22306259
Br J Anaesth. 2012 Mar;108(3):384-94
pubmed: 22290457
Anesthesiology. 2000 Sep;93(3):858-75
pubmed: 10969322
Shock. 2015 May;43(5):450-5
pubmed: 25692257
Circulation. 2007 Oct 23;116(17):1896-906
pubmed: 17923576
Crit Care. 2014 Dec 23;18(6):707
pubmed: 25629597
Crit Care Med. 2011 Apr;39(4):695-701
pubmed: 21220999
Exp Physiol. 2016 Jan;101(1):34-40
pubmed: 26498127
Ann Thorac Surg. 2015 Mar;99(3):926-31
pubmed: 25601655
Curr Opin Crit Care. 2008 Jun;14(3):361-6
pubmed: 18467900
Biomed Res Int. 2013;2013:502194
pubmed: 24027757
Intensive Care Med. 2008 Sep;34(9):1600-7
pubmed: 18523754
Cochrane Database Syst Rev. 2015 Jul 16;(7):CD009642
pubmed: 26184397
Anesth Analg. 2017 Jun;124(6):2054-2062
pubmed: 28525515
J Anesth. 2015 Apr;29(2):269-78
pubmed: 25082728