Efficacy of intravenous Lidocaine in controlling emergence agitation in children for surgery under Sevoflurane anesthesia: a meta-analysis
Niña Kashka E. Pamintuan | Ana Maria de la Cerna
Discipline: medicine by specialism
Abstract:
BACKGROUND: Emergence delirium is a state of mental confusion and agitation after wakening from anesthesia that may result in traumatic injuries to the child. Limited drugs have been studied or used to prevent this occurrence.
OBJECTIVE: To determine the efficacy and safety of intravenous lidocaine in controlling emergence agitation (EA) in children undergoing surgeries done under general anesthesia compared to placebo or other intravenous anesthetics.
METHODOLOGY: This study is a meta-analysis, where published articles were obtained using PubMed, Cochrane Library, Clinical Trials, and Google Scholar up to August 2022. The primary outcome measure includes incidence of emergence delirium while secondary outcomes are postoperative pain and adverse effects comparing lidocaine and other intravenous drugs. The latter includes nausea and vomiting, untoward airway events and local anesthetic toxicity (LAST). Review Manager 5.4 was used for statistical analysis.
RESULTS: There were a total of 6 articles included for quantitative and qualitative analysis. The overall incidence of emergence agitation (RR=1.03, 95% CI [0.50, 2.13], P=0.94) and adverse events were higher in the Lidocaine group, although the differences were not significant. Subgroup analysis by comparator showed significant increased risk of developing EA with Lidocaine compared to other intravenous drugs (RR=2.06, 95% CI [1.32, 2.32], P=0.002). The risk for developing postoperative pain is decreased with Lidocaine compared to placebo and other drugs.
CONCLUSION: Intravenous lidocaine given to children undergoing general anesthesia with sevoflurane increased their risk for emergence delirium, compared to both placebo and other intravenous anesthetics.
References:
- Stamper, M., Hawks, S., Taicher, B., Bonta, J. and Brandon, D., 2014. Identifying Pediatric Emergence Agitation by Using the PAED Scale: A Quality Improvement Project. AORN Journal, 99(4), pp.480-494.
- Kuratani, N. and Oi, Y., 2008. Greater Incidence of Emergence Agitation in Children after Sevoflurane Anesthesia as Compared with Halothane. Anesthesiology, 109(2), pp.225-232.
- Yamashita, M., 2003. Postanaesthetic excitation and agitation. Pediatric Anesthesia, 13(7), pp.641-641.
- Rahimzadeh, P., Faiz, S., Alebouyeh, M., Dasian, A. and Sayarifard, A., 2014. Appropriate Anesthesia Regimen to Control Sevoflurane-Induced Emergence Agitation in Children: Propofol–Lidocaine and Thiopental Sodium–Lidocaine: A Randomized Controlled Trial. Iranian Red Crescent Medical Journal, 16(7).
- Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: acomparison with halothane. PaediatrAnaesth. 2000;10:419---24.7
- Barreto, A., Paschoal, A., Farias, C., Borges, P., Andrade, R. and de Orange, F., 2018. Risk factors associated with anesthesia emergence agitation in children undergoing outpatient surgery. Brazilian Journal of Anesthesiology (English Edition), 68(2), pp.162-167.
- Wofford, K., and Vacciano, C. (2011). Sorting through the confusion: Adverse cognitive change after surgery in adults. AANA Journal, 79(4), 335-342.
- Lee, J. and Lee, K., 2007. Intravenous lidocaine prior to extubation reduces postextubation cough and agitation in children undergoing tonsillectomy and adenoidectomy. European Journal of Anaesthesiology, 24(Supplement 39), p.134.
- Both, C., Thomas, J., Bühler, P., Schmitz, A., Weiss, M. and Piegeler, T., 2018. Factors associated with intravenous lidocaine in pediatric patients undergoing laparoscopic appendectomy – a retrospective, single-centre experience. BMC Anesthesiology, 18(1).
- Jang, Y. and Oh, S., 2005. Intravenous Lidocaine does not Reduce Emergence Agitation or Pain after Sevoflurane Anesthesia in Children. Korean Journal of Anesthesiology, 49(6), p.S14.
- Echevarría, G., Altermatt, F., Paredes, S., Puga, V., Auad, H., Veloso, A. and Elgueta, M., 2018. Intra-operative lidocaine in the prevention of vomiting after elective tonsillectomy in children. European Journal of Anaesthesiology, 35(5), pp.343-348.
- Ji, J., Park, J., Kim, J., Kim, D., Chung, J., Chun, H., Jung, H. and Yoo, S., 2019. Effect of esmolol and lidocaine on agitation in awake phase of anesthesia among children. Chinese Medical Journal, 132(7), pp.757-764.
- Lee, S. and Sung, T., 2020. Emergence agitation: current knowledge and unresolved questions. Korean Journal of Anesthesiology, 73(6), pp.471-485.
- Dunn, L. and Durieux, M., 2017. Perioperative Use of Intravenous Lidocaine. Anesthesiology, 126(4), pp.729-737.
- Boveroux P, Vanhaudenhuyse A, Bruno MA, Noirhomme Q, Lauwick S, Luxen A, et al. Breakdown of within- and between-network resting state functional magnetic resonance imaging connectivity during propofol-induced loss of consciousness. Anesthesiology. 2010;113:1038–53.
- Bonhomme V, Boveroux P, Brichant JF, Laureys S, Boly M. Neural correlates of consciousness during general anesthesia using functional magnetic resonance imaging (fMRI) Arch Ital Biol. 2012;150:155–63.
- Auoad, M., et. al. 2008. A Single Dose of Propofol at the End of Surgery for the Prevention of Emergence Agitation in Children Undergoing Strabismus Surgery During Sevoflurane Anesthesia. Survey of Anesthesiology, 52(3), pp.133-134.
- Weibel, S., Jokinen, J., Pace, N., Schnabel, A., Hollmann, M., Hahnenkamp, K., Eberhart, L., Poepping, D., Afshari, A. and Kranke, P., 2016. Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: a systematic review with trial sequential analysis † †This review is an abridged version of a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2015, Issue 7, DOI: CD009642 (see www.thecochranelibrary.com for information).1 Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review. British Journal of Anaesthesia, 116(6), pp.770-783.
- Li, Y., Wingrove, D., Too, P., Marnerakis, M., Stimson, E., Strichartz, G. and Maggio, J., 1995. Local Anesthetics Inhibit Substance P Binding and Evoked Increases in Intracellular Calcium sup 2+. Anesthesiology, 82(1), pp.166-173.
- Beecham, G., Nessel, T. and Goyal, A., 2022. Lidocaine. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK539881/ [Accessed 14 March 2022].
- Seo, I., Seong, C., Jung, G., Park, S., Kim, S. and Kim, M., 2012. The effect of sub-Tenon lidocaine injection on emergence agitation after general anaesthesia in paediatric strabismus surgery. European Journal of Anaesthesiology, 29(1), p.53.
- 22.Reduque, L. and Verghese, S., 2013. Paediatric emergence agitation. Continuing Education in Anaesthesia Critical Care & Pain, 13(2), pp.39-41.
- Shamim, F., Ullah, H. and Khan, F., 2015. Postoperative pain assessment using four behavioral scales in Pakistani children undergoing elective surgery. Saudi Journal of Anaesthesia, 9(2), p.174.
- Rose, D., Cohen, M., Wigglesworth, D. and DeBoer, D., 1994. Critical Respiratory Events in the Postanesthesia Care Unit. Anesthesiology, 81(2), pp.410-418.
- Mahajan, A. and Derian, A., 2022. Local Anesthetic Toxicity. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK499964/#:~:text=Initial%20signs%20and%20symptoms%20include,arrest%2C%20and%2For%20coma. [Accessed 14 March 2022].
- Moher D, Liberati A, et.al. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA statement. PLos Med 6(6): e1000097. Doi:10.1371/journal.pmed1000097
- Gupta A, Stierer T, Zuckerman R, Sakima N, Parker S, Fleisher L. Comparison of Recovery Profile After Ambulatory Anesthesia with Propofol, Isoflurane, Sevoflurane and Desflurane: A Systematic Review. Anesthesia & Analgesia. 2004;:632-641
- Manouchehrian N, Abbasi R, Jiryaee N, Beigi R. Comparison of intravenous injection of magnesium sulfate and lidocaine effectiveness on the prevention of laryngospasm and analgesic requirement in tonsillectomy. European Journal of Translational Myology. 2022.
ISSN 2704-3665 (Online)
ISSN 0117-3774 (Print)