Effect of intravenous lidocaine on propofol consumption in elderly patients undergoing colonoscopy: a double-blinded, randomized, controlled trial

Li, Meizhen; Ke, Weiqi; Zhuang, Shaohui

doi:10.1186/s12871-022-01601-z

Cited by 6 publications

(5 citation statements)

References 25 publications

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“…Our study found that the ED50 of propofol induction dose in elderly patients undergoing painless gastroscopy was 0.670 mg/kg when combined with intravenous lidocaine, a significant 40% reduction from the ED50 of 1.118 mg/kg without lidocaine. The finding regarding the propofol-sparing effect of intravenous lidocaine was consistent with previous studies (Chen et al 2020 ; Hu et al 2022 ; Li et al 2022 ). The mechanism underlying this propofol-sparing effect may be attributed to the anti-nociceptive stimulus of lidocaine in this patient group(Hans et al 2010 ).…”

Section: Discussionsupporting

confidence: 92%

Effect of intravenous lidocaine on the ED50 of propofol induction dose in elderly patients undergoing painless gastroscopy: a prospective, randomized, double-blinded, controlled study

Tang,

Lv,

Sun

et al. 2024

Perioper Med

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Background Intravenous lidocaine could be a potential alternative adjuvant to propofol-based sedation for gastroscopy in elderly patients. This study aimed to evaluate the effect of intravenous lidocaine on the median effective dose (ED50) of propofol induction dose in elderly patients undergoing painless gastroscopy. Methods The study included 70 patients aged ≥ 60 years undergoing painless gastroscopy with 64 randomly assigned to either group L (2% lidocaine 1.5 mg/kg, n = 31) or group N (equal volume normal saline, n = 33). All patients received propofol induction following 0.1 μg/kg intravenous sufentanil. The Dixon “up-and-down” sequential method was used, with a 1.5 mg/kg initial induction dose of propofol followed by a 0.1 mg/kg sequential variable dose. The primary endpoint was the ED50 of the propofol induction dose. The total propofol dose, recovery time, adverse events, and local anesthetic intoxication reactions were also recorded. Results The ED50 of propofol induction dose was 0.670 (95% confidence interval [CI] 0.216–0.827) mg/kg in group L and 1.118 (95% CI 0.803–1.232) mg/kg in group N. There was a statistically significant difference between the two groups (p < 0.001). The incidence of hypotension and propofol injection pain were lower in group L than in group N (p < 0.05). Furthermore, the orientation recovery time in group L was shorter compared to group N (p < 0.05). None of the participants in group L observed local anesthetic intoxication reactions after receiving lidocaine. Conclusions The administration of intravenous lidocaine to elderly patients undergoing painless gastroscopy resulted in a significant 40% reduction in the ED50 of propofol induction dose, which may be related to the decreased incidence of hypotension and injection pain, as well as the improved post-gastroscopy orientation recovery. Trial registration ChiCTR, ChiCTR2200065530. Registered on 08 November 2022.

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Section: Discussionsupporting

confidence: 92%

Effect of intravenous lidocaine on the ED50 of propofol induction dose in elderly patients undergoing painless gastroscopy: a prospective, randomized, double-blinded, controlled study

Tang,

Lv,

Sun

et al. 2024

Perioper Med

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“…Propofol has the advantages of rapid onset and quick recovery and is often used in gastroscopy [6]. However, propofol quickly causes adverse side effects, including hypotension and hypoxemia [7][8][9], and propofol injection pain also cannot be ignored [10]. Alfentanil is a short-acting opioid analgesic with high analgesic intensity and similar complication risks to other opioids.…”

Section: Introductionmentioning

confidence: 99%

Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

et al. 2022

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Background Remimazolam is a newer benzodiazepine with properties of rapid onset, short duration of action, and fast recovery. Our study was to evaluate the effects of different doses of remimazolam combined with alfentanil in colonoscopic polypectomy. Methods One hundred twenty patients were randomly divided into four groups: alfentanil and propofol (AP) group, alfentanil and remimazolam 0.1 mg/kg (AR1 group), 0.15 mg/kg (AR2 group), or 0.2 mg/kg (AR3 group). Patients in the four groups received alfentanil 10 μg/kg, followed by propofol 2 mg/kg and three dosages of remimazolam. Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scale, heart rate (HR), oxygen saturation (SpO2), respiratory rate (RR), bispectral index (BIS) values and mean arterial pressure (MAP) were collected at intervals of 5 min and analyzed at different time points: before anesthesia (T0), 5 min (T1), 10 min (T2), 15 min after anesthesia (T3) and at the end of surgery (T4). The average MAP was calculated utilizing the average of all MAP values. The primary outcome was the success rate of sedation. Secondary outcomes included time to full alert and adverse events. Results The success rate of sedation was 100% among the four groups. The incidence of hypotension was significantly decreased (all P < 0.05) and the average MAP was higher in AR1-AR3 groups than AP group (all P < 0.001). None of the patients developed bradycardia or hypertension during surgery in all study groups. BIS values were higher (all P < 0.001) and the time to full alert was statistically shorter in AR1-AR3 groups (all P < 0.05) compared with the AP group. The MOAA/S score in AR1 was higher than AR2 (P < 0.05) and the AR3 group (P < 0.05) at T1 and BIS values in the AR1 group were significantly higher than AR3 group (P < 0.05) at T4. Conclusions Remimazolam combined with alfentanil have a non-inferior sedative effect than propofol during the colonoscopic polypectomy. Moreover, this combination of two short-acting drugs might be a safer alternative. Trial registration The clinical trial was registered on (16/05/2021, ChiCTR2100046492).

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“…The literature also indicates that LID can reduce propofol needs during colonoscopy anesthesia, although the evidence is less uniform than that for KET, showing greater variance [27][28][29][30]. For instance, Forster et al reported a 50% reduction in total propofol use with LID infusion, whereas Li et al observed only a 13.2% decrease [27,28]. Such variation could be attributed to the LID dosage, usage of additional drugs, and patient demographics.…”

Section: Propofol-sparing Effectmentioning

confidence: 99%

Comparison of Fentanyl, Ketamine, and Lidocaine Combined with Propofol Anesthesia in Patients with Crohn Disease Undergoing Colonoscopy

Chudziński,

Szułdrzyński,

Jankowski

et al. 2024

Med Sci Monit

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Background Colonoscopy is the predominant invasive procedure for Crohn disease (CD) patients. Opioids and propofol carry risks of respiratory and cardiovascular complications. This study aimed to evaluate whether substituting fentanyl with ketamine or lidocaine could diminish propofol usage and minimize adverse events. Material/Methods In total, 146 patients with CD scheduled for elective colonoscopy were assigned to anesthesia with fentanyl (n=47), ketamine (n=47), or lidocaine (n=55). Propofol was administered to achieve sufficient anesthesia. Measured outcomes in each group included propofol consumption, hypotension and desaturation incidents, adverse event types, consciousness recovery time, abdominal pain intensity, Aldrete scale, and Post Anaesthetic Discharge Scoring System (PADSS). Results Patients administered fentanyl needed significantly more propofol ( P =0.017) than those on ketamine, with lidocaine showing no notable difference ( P =0.28). Desaturation was significantly less common in the ketamine and lidocaine groups than fentanyl group ( P <0.001). The ketamine group experienced milder reductions in mean arterial ( P =0.018) and systolic blood pressure ( P <0.001). Recovery metrics (Aldrete and PADSS scores) were lower for fentanyl ( P <0.001 ) , although satisfaction and pain levels were consistent across all groups ( P =0.797). Dizziness occurred less frequently with lidocaine than fentanyl (17.2%, P =0.018) and ketamine (15.1%, P =0.019), while metallic taste incidents were more prevalent in the lidocaine group (13.5%, P =0.04) than fentanyl group. Conclusions Using ketamine or lidocaine instead of fentanyl in anesthesia for colonoscopy in patients with CD significantly lowers propofol use, reduces desaturation events, maintains blood pressure more effectively, without increasing hypotension risk, and accelerates recovery, without negatively impacting adverse events or patient satisfaction.

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Effect of intravenous lidocaine on propofol consumption in elderly patients undergoing colonoscopy: a double-blinded, randomized, controlled trial

Cited by 6 publications

References 25 publications

Effect of intravenous lidocaine on the ED50 of propofol induction dose in elderly patients undergoing painless gastroscopy: a prospective, randomized, double-blinded, controlled study

Effect of intravenous lidocaine on the ED50 of propofol induction dose in elderly patients undergoing painless gastroscopy: a prospective, randomized, double-blinded, controlled study

Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

Comparison of Fentanyl, Ketamine, and Lidocaine Combined with Propofol Anesthesia in Patients with Crohn Disease Undergoing Colonoscopy

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