Prevention of hemodynamics response to tracheal extubation by administration of lidocaine prior to extubation: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

MA Zhimin ^1,2 , AI Feiling ^1,2 , LIU Sitong ^1,2 , WEN Jing ^1,2 , WEN Fuyuan ^1,2 , ZHAO Yuhan ^1,2 , YIN Meihua ^1,2 , XU Chaonan ^1,2 , ZHOU Yanming ^1,2 , LIU Yingying ^1,2 , ZHANG Shan ^1,2 ,  LOU Jingsheng ³ ,  YANG Xinghua ^1,2

1. School of Public Health, Capital Medical University, Beijing, 100069, P.R.China;
2. Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, P.R.China;
3. Anesthesia and Option Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China;

Corresponding author：

LOU Jingsheng, Email: loujingsheng@163.com; YANG Xinghua, Email: xinghuay@sina.com

Keywords：

Lidocaine; General anesthesia; Tracheal extubation; Hemodynamic response; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201809015

Video：

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Objectives To systematically review the efficacy of lidocaine injected prior to tracheal extubation in preventing hemodynamic responses to tracheal extubation in general anesthesia.Methods PubMed, Ovid, Web of Science, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of lidocaine administrated prior to extubation in preventing hemodynamic responses to tracheal extubation in patients undergoing general anesthesia from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 and Stata 13.0 software.Results A total of 10 RCTs involving 525 patients were included. The results of meta-analysis showed that: compared with control group, lidocaine could reduce mean arterial pressure in 5 min after extubation (MD=–5.10, 95%CI –9.41 to –0.79, P=0.02), weaken the increase in systolic blood pressure caused by extubation from the moment before extubation to 5 minutes after extubation (before extubation: MD=–7.22, 95%CI –10.34 to –4.11, P<0.000 01; at extubation: MD=–14.02, 95%CI –19.42 to –8.62, P<0.000 01; 1 minutes after extubation: MD=–15.82, 95%CI –22.20 to –9.45, P<0.000 01; 3 minutes after extubation: MD=–12.55, 95%CI –20.36 to –4.74, P=0.002; and 5 minutes after extubation: MD=–12.05, 95%CI –20.35 to –3.74, P=0.004), and weakened extubation-induced increase in diastolic blood pressure at extubation (MD=–9.71, 95%CI –16.57 to –2.86, P=0.005). In addition, lidocaine inhibited heart rate in all time points except the moment of before and at 10 minutes after extubation.Conclusions Current evidence shows that lidocaine can inhibit the increase in blood pressure and heart rate caused by extubation at certain times. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.

Citation： MA Zhimin, AI Feiling, LIU Sitong, WEN Jing, WEN Fuyuan, ZHAO Yuhan, YIN Meihua, XU Chaonan, ZHOU Yanming, LIU Yingying, ZHANG Shan, LOU Jingsheng, YANG Xinghua. Prevention of hemodynamics response to tracheal extubation by administration of lidocaine prior to extubation: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(5): 587-594. doi: 10.7507/1672-2531.201809015 Copy

1.	刘俊杰, 赵俊. 现代麻醉学(第2版). 北京: 人民卫生出版社, 1997.
2.	Tobias JD. Etomidate: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med, 2000, 1(2): 100-106.
3.	李九妹, 赵伟, 洪永朝. 气管内和静脉应用利多卡因预防气管插管所致心血管反应的效果比较. 云南医药, 2003, 24(1): 22-23.
4.	Lee JH, Koo BN, Jeong JJ, et al. Differential effects of lidocaine and remifentanil on response to the tracheal tube during emergence from general anaesthesia. Br J Anaesth, 2011, 106(3): 410-415.
5.	Poulin L, Gaulin F, Arcand G, et al. A prospective randomized double blind trial comparing the efficacy of a bolus of IV lidocaine and remifentanyl on the incidence of coughing at emergence. Anesth Analg, 2014, 118: S36.
6.	李敏, 张建友, 孙建宏. 氟比洛酚酯联合利多卡因预防拔管期应激反应的临床观察. 实用临床医药杂志, 2012, 16(22): 109-111.
7.	Uzun S, Yuce Y, Erden A, et al. Impact of perioperative lidocaine infusion and bis monitorization on remifentanil dosage in hypotensive anesthesia. Eur Rev Med Pharmacol Sci, 2014, 18(4): 559-565.
8.	吕美红, 于维颖. BIS监测下复方利多卡因软膏对全麻拔管时患者血流动力学的影响. 大家健康(学术版), 2012, 6(6): 22-24.
9.	张秦, 陈春玲. 不同药物预防全麻拔管期间心血管反应的观察. 新疆医科大学学报, 2009, 32(2): 201-203.
10.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
11.	王丹, 翟俊霞, 牟振云, 等. Meta分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10): 1115-1118.
12.	杜玄凌, 徐琦坪, 潘独伊, 等. 铝碳酸镁治疗反流性食管炎的Meta分析. 中国循证医学杂志, 2018, 18(9): 924-930.
13.	Bidwai AV, Bidwai VA, Rogers CR, et al. Blood-pressure and pulse-rate responses to endotracheal extubation with and without prior injection of lidocaine. Anesthesiology, 1979, 51(2): 171-173.
14.	孟晶. 曲马多与利多卡因对于减轻拔管反应作用的比较. 长春: 吉林大学, 2007.
15.	李远强. 不同方法减轻神经外科术后气管拔管反应的临床研究. 南宁: 广西医科大学, 2008.
16.	曹观海. 可实施表面麻醉的气管插管的制作与临床应用. 长春: 吉林大学, 2013.
17.	陈窈丽, 张天伟. 利多卡因对气管拔管心血管反应的作用及护理观察. 中国实用医药, 2013, 8(24): 236-238.
18.	朱磊, 姜凤鸣, 金立民, 等. 利多卡因静脉注射用于减轻全麻气管拔管时心血管应激反应的临床研究. 中国实验诊断学, 2013, 17(4): 731-732.
19.	傅国强, 王兰, 李连红. 利多卡因不同给药方法对全麻苏醒拔管时血流动力学变化的影响. 临床麻醉学杂志, 2007, 23(1): 72-73.
20.	原皓, 邹亮. 静脉注射利多卡因复合头抬高位对拔管引起的血流动力学改变及呛咳反应的影响. 中国医刊, 2017, 52(12): 82-85.
21.	李荣, 张中军, 毛洪雅, 等. 罗哌卡因与利多卡因气道表面麻醉对气管插管及拔管反应影响的比较. 临床麻醉学杂志, 2016, 32(5): 504-505.
22.	覃宝全. 前列腺素E_1预防全麻气管内插管心血管副反应的观察. 右江民族医学院学报, 2000, 22(6): 924-925.
23.	刘志双, 孟庆云, 柳顺锁, 等. 前列腺素E_1预防全麻气管内插管心血管副反应的观察. 中华麻醉学杂志, 1999, 19(5): 22-25.
24.	唐世美, 彭章龙, 于布为. 尼卡地平、拉贝洛尔和利多卡因预防全麻拔管心血管反应的比较. 临床麻醉学杂志, 2002, 18(8): 444-445.
25.	Mikawa K, Nishina K, Takao Y, et al. Attenuation of cardiovascular responses to tracheal extubation: comparison of verapamil, lidocaine, and verapamil-lidocaine combination. Anesth Analg, 1997, 85(5): 1005-1010.
26.	时胜男, 左明章, 李晓琳. 术中静脉输注利多卡因对老年患者全麻下非心脏手术后认知功能的影响. 中华麻醉学杂志, 2009, 29(6): 575-576.
27.	Koga K, Asai T, Vaughan RS, et al. Respiratory complications associated with tracheal extubation. Timing of tracheal extubation and use of the laryngeal mask during emergence from anaesthesia. Anaesthesia, 1998, 53(6): 540-544.
28.	Xing CY, Liu YL, Zhao ML, et al. New method for noninvasive quantification of central venous pressure by ultrasound. Circ Cardiovasc Imaging, 2015, 8(5): e003085.
29.	Sathish N, Singh NG, Nagaraja PS, et al. Comparison between noninvasive measurement of central venous pressure using near infrared spectroscopy with an invasive central venous pressure monitoring in cardiac surgical intensive care unit. Ann Card Anaesth, 2016, 19(3): 405-409.
30.	Pandey CK, Raza M, Ranjan R, et al. Intravenous lidocaine suppresses fentanyl-induced coughing: a double-blind, prospective, randomized placebo-controlled study. Anesth Analg, 2004, 99(6): 1696-1698.
31.	Groeben H, Silvanus MT, Beste M, et al. Both intravenous and inhaled lidocaine attenuate reflex bronchoconstriction but at different plasma concentrations. Am J Respir Crit Care Med, 1999, 159(2): 530-535.

1. 刘俊杰, 赵俊. 现代麻醉学(第2版). 北京: 人民卫生出版社, 1997.
2. Tobias JD. Etomidate: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med, 2000, 1(2): 100-106.
3. 李九妹, 赵伟, 洪永朝. 气管内和静脉应用利多卡因预防气管插管所致心血管反应的效果比较. 云南医药, 2003, 24(1): 22-23.
4. Lee JH, Koo BN, Jeong JJ, et al. Differential effects of lidocaine and remifentanil on response to the tracheal tube during emergence from general anaesthesia. Br J Anaesth, 2011, 106(3): 410-415.
5. Poulin L, Gaulin F, Arcand G, et al. A prospective randomized double blind trial comparing the efficacy of a bolus of IV lidocaine and remifentanyl on the incidence of coughing at emergence. Anesth Analg, 2014, 118: S36.
6. 李敏, 张建友, 孙建宏. 氟比洛酚酯联合利多卡因预防拔管期应激反应的临床观察. 实用临床医药杂志, 2012, 16(22): 109-111.
7. Uzun S, Yuce Y, Erden A, et al. Impact of perioperative lidocaine infusion and bis monitorization on remifentanil dosage in hypotensive anesthesia. Eur Rev Med Pharmacol Sci, 2014, 18(4): 559-565.
8. 吕美红, 于维颖. BIS监测下复方利多卡因软膏对全麻拔管时患者血流动力学的影响. 大家健康(学术版), 2012, 6(6): 22-24.
9. 张秦, 陈春玲. 不同药物预防全麻拔管期间心血管反应的观察. 新疆医科大学学报, 2009, 32(2): 201-203.
10. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
11. 王丹, 翟俊霞, 牟振云, 等. Meta分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10): 1115-1118.
12. 杜玄凌, 徐琦坪, 潘独伊, 等. 铝碳酸镁治疗反流性食管炎的Meta分析. 中国循证医学杂志, 2018, 18(9): 924-930.
13. Bidwai AV, Bidwai VA, Rogers CR, et al. Blood-pressure and pulse-rate responses to endotracheal extubation with and without prior injection of lidocaine. Anesthesiology, 1979, 51(2): 171-173.
14. 孟晶. 曲马多与利多卡因对于减轻拔管反应作用的比较. 长春: 吉林大学, 2007.
15. 李远强. 不同方法减轻神经外科术后气管拔管反应的临床研究. 南宁: 广西医科大学, 2008.
16. 曹观海. 可实施表面麻醉的气管插管的制作与临床应用. 长春: 吉林大学, 2013.
17. 陈窈丽, 张天伟. 利多卡因对气管拔管心血管反应的作用及护理观察. 中国实用医药, 2013, 8(24): 236-238.
18. 朱磊, 姜凤鸣, 金立民, 等. 利多卡因静脉注射用于减轻全麻气管拔管时心血管应激反应的临床研究. 中国实验诊断学, 2013, 17(4): 731-732.
19. 傅国强, 王兰, 李连红. 利多卡因不同给药方法对全麻苏醒拔管时血流动力学变化的影响. 临床麻醉学杂志, 2007, 23(1): 72-73.
20. 原皓, 邹亮. 静脉注射利多卡因复合头抬高位对拔管引起的血流动力学改变及呛咳反应的影响. 中国医刊, 2017, 52(12): 82-85.
21. 李荣, 张中军, 毛洪雅, 等. 罗哌卡因与利多卡因气道表面麻醉对气管插管及拔管反应影响的比较. 临床麻醉学杂志, 2016, 32(5): 504-505.
22. 覃宝全. 前列腺素E_1预防全麻气管内插管心血管副反应的观察. 右江民族医学院学报, 2000, 22(6): 924-925.
23. 刘志双, 孟庆云, 柳顺锁, 等. 前列腺素E_1预防全麻气管内插管心血管副反应的观察. 中华麻醉学杂志, 1999, 19(5): 22-25.
24. 唐世美, 彭章龙, 于布为. 尼卡地平、拉贝洛尔和利多卡因预防全麻拔管心血管反应的比较. 临床麻醉学杂志, 2002, 18(8): 444-445.
25. Mikawa K, Nishina K, Takao Y, et al. Attenuation of cardiovascular responses to tracheal extubation: comparison of verapamil, lidocaine, and verapamil-lidocaine combination. Anesth Analg, 1997, 85(5): 1005-1010.
26. 时胜男, 左明章, 李晓琳. 术中静脉输注利多卡因对老年患者全麻下非心脏手术后认知功能的影响. 中华麻醉学杂志, 2009, 29(6): 575-576.
27. Koga K, Asai T, Vaughan RS, et al. Respiratory complications associated with tracheal extubation. Timing of tracheal extubation and use of the laryngeal mask during emergence from anaesthesia. Anaesthesia, 1998, 53(6): 540-544.
28. Xing CY, Liu YL, Zhao ML, et al. New method for noninvasive quantification of central venous pressure by ultrasound. Circ Cardiovasc Imaging, 2015, 8(5): e003085.
29. Sathish N, Singh NG, Nagaraja PS, et al. Comparison between noninvasive measurement of central venous pressure using near infrared spectroscopy with an invasive central venous pressure monitoring in cardiac surgical intensive care unit. Ann Card Anaesth, 2016, 19(3): 405-409.
30. Pandey CK, Raza M, Ranjan R, et al. Intravenous lidocaine suppresses fentanyl-induced coughing: a double-blind, prospective, randomized placebo-controlled study. Anesth Analg, 2004, 99(6): 1696-1698.
31. Groeben H, Silvanus MT, Beste M, et al. Both intravenous and inhaled lidocaine attenuate reflex bronchoconstriction but at different plasma concentrations. Am J Respir Crit Care Med, 1999, 159(2): 530-535.

Chinese Journal of Evidence-Based Medicine

Prevention of hemodynamics response to tracheal extubation by administration of lidocaine prior to extubation: a meta-analysis

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