Background: In craniotomy tumor removal, brain relaxation after dura opening is essential. Lidocaine is known to have analgesic and antiinflammatory effects. It is excellent in decreasing cerebral metabolic rate of oxygen, cerebral blood flow, and cerebral blood volume; and can potentially reduce intracranial pressure, resulting in exceptional brain relaxation after dura opening. However, no study has examined continuous intravenous lidocaine infusion on brain relaxation, intraoperative opioid consumption and surgeon's satisfaction in adult patients undergoing craniotomy tumor removal.Methods: A total of 60 subjects scheduled for craniotomy tumor removal were enrolled in a double-blind, randomized controlled trial with consecutive sampling. Patients received either an intravenous bolus of lidocaine (2%) 1.5 mg/kg before induction followed by 2 mg/kg/h continuous infusion up to skin closure (lidocaine group) or placebo with similar volume (NaCl 0.9%). Neurosurgeons evaluated brain relaxation and surgeon's satisfaction with a 4-point scale, total intraoperative opioid consumption was recorded in μg and μg/kg/min.Results: All sixty subjects were included in the study. Lidocaine group showed better brain relaxation after dura opening (96.7% vs 70%; lidocaine vs placebo, P < .006), less intraoperative fentanyl consumption (369.2 μg vs 773.0 μg; P < .001, .0107 vs .0241 μg/kg/min; lidocaine vs placebo, P < .001). Higher surgeon's satisfaction was found in lidocaine group (96.7% vs 70%, P = .006). No side effects were observed during this study.Conclusions: Continuous lidocaine intravenous infusion improves brain relaxation after dura opening, and decreases intraoperative opioid consumption, with good surgeon satisfaction in adult patients undergoing craniotomy tumor removal.Abbreviations: CBF = cerebral blood flow, CMRgluc = cerebral metabolic rate for glucose, CMRO 2 = cerebral metabolic rate of oxygen, ICP = intracranial pressure, PMNs = polymorphonuclear cells.

No abstract

The usage of hypotonic irrigation solution during hysteroscopy and laparoscopy can cause systemic fluid absorption and complications such as hyponatremia, fluid overload, and cerebral edema. Moreover, Trendelenburg position on gynecologic laparoscopy with a long duration can increase intracranial pressure and decrease cerebral perfusion pressure. A woman, 39 years old, suffered from severe hyponatremia and cerebral edema after hysteroscopy myomectomy, laparoscopic salpingectomy, adenomyosis resection, and adhesiolysis procedure. Water for injection was used as an irrigation solution during the procedure, totaling 20 L. The position of the procedure was supine, Trendelenburg, with a procedure duration of 4 h 50 min. A spontaneous respiratory trigger was not found for about 1 h during extubation. We found anisochoric pupil 5/4 mm without direct and indirect light reflex on physical examination. From the laboratory result, the sodium level was 118. Brain CT scan with contrast showed cerebral edema. Sodium correction was given using NaCl 3%, 500 mL/24 h IV drip. Sodium was corrected slowly and cautiously to prevent cerebral pontine myelinolysis. In the ICU, the sodium level was increased to a normal level. But, the light reflex was still absent, and the pupil was anisochoric. Brain MRI showed diffuse cerebral edema.