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.	劉俊杰, 趙俊. 現代麻醉學(第2版). 北京: 人民衛生出版社, 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, 趙偉, 洪永朝. 氣管內和靜脈應用利多卡因預防氣管插管所致心血管反應的效果比較. 云南醫藥, 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, 張建友, 孫建宏. 氟比洛酚酯聯合利多卡因預防拔管期應激反應的臨床觀察. 實用臨床醫藥雜志, 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.	呂美紅, 于維穎. BIS監測下復方利多卡因軟膏對全麻拔管時患者血流動力學的影響. 大家健康(學術版), 2012, 6(6): 22-24.
9.	張秦, 陳春玲. 不同藥物預防全麻拔管期間心血管反應的觀察. 新疆醫科大學學報, 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分析中的異質性及其處理方法. 中國循證醫學雜志, 2009, 9(10): 1115-1118.
12.	杜玄凌, 徐琦坪, 潘獨伊, 等. 鋁碳酸鎂治療反流性食管炎的Meta分析. 中國循證醫學雜志, 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. 曲馬多與利多卡因對于減輕拔管反應作用的比較. 長春: 吉林大學, 2007.
15.	李遠強. 不同方法減輕神經外科術后氣管拔管反應的臨床研究. 南寧: 廣西醫科大學, 2008.
16.	曹觀海. 可實施表面麻醉的氣管插管的制作與臨床應用. 長春: 吉林大學, 2013.
17.	陳窈麗, 張天偉. 利多卡因對氣管拔管心血管反應的作用及護理觀察. 中國實用醫藥, 2013, 8(24): 236-238.
18.	朱磊, 姜鳳鳴, 金立民, 等. 利多卡因靜脈注射用于減輕全麻氣管拔管時心血管應激反應的臨床研究. 中國實驗診斷學, 2013, 17(4): 731-732.
19.	傅國強, 王蘭, 李連紅. 利多卡因不同給藥方法對全麻蘇醒拔管時血流動力學變化的影響. 臨床麻醉學雜志, 2007, 23(1): 72-73.
20.	原皓, 鄒亮. 靜脈注射利多卡因復合頭抬高位對拔管引起的血流動力學改變及嗆咳反應的影響. 中國醫刊, 2017, 52(12): 82-85.
21.	李榮, 張中軍, 毛洪雅, 等. 羅哌卡因與利多卡因氣道表面麻醉對氣管插管及拔管反應影響的比較. 臨床麻醉學雜志, 2016, 32(5): 504-505.
22.	覃寶全. 前列腺素E_1預防全麻氣管內插管心血管副反應的觀察. 右江民族醫學院學報, 2000, 22(6): 924-925.
23.	劉志雙, 孟慶云, 柳順鎖, 等. 前列腺素E_1預防全麻氣管內插管心血管副反應的觀察. 中華麻醉學雜志, 1999, 19(5): 22-25.
24.	唐世美, 彭章龍, 于布為. 尼卡地平、拉貝洛爾和利多卡因預防全麻拔管心血管反應的比較. 臨床麻醉學雜志, 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.	時勝男, 左明章, 李曉琳. 術中靜脈輸注利多卡因對老年患者全麻下非心臟手術后認知功能的影響. 中華麻醉學雜志, 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. 劉俊杰, 趙俊. 現代麻醉學(第2版). 北京: 人民衛生出版社, 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, 趙偉, 洪永朝. 氣管內和靜脈應用利多卡因預防氣管插管所致心血管反應的效果比較. 云南醫藥, 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, 張建友, 孫建宏. 氟比洛酚酯聯合利多卡因預防拔管期應激反應的臨床觀察. 實用臨床醫藥雜志, 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. 呂美紅, 于維穎. BIS監測下復方利多卡因軟膏對全麻拔管時患者血流動力學的影響. 大家健康(學術版), 2012, 6(6): 22-24.
9. 張秦, 陳春玲. 不同藥物預防全麻拔管期間心血管反應的觀察. 新疆醫科大學學報, 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分析中的異質性及其處理方法. 中國循證醫學雜志, 2009, 9(10): 1115-1118.
12. 杜玄凌, 徐琦坪, 潘獨伊, 等. 鋁碳酸鎂治療反流性食管炎的Meta分析. 中國循證醫學雜志, 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. 曲馬多與利多卡因對于減輕拔管反應作用的比較. 長春: 吉林大學, 2007.
15. 李遠強. 不同方法減輕神經外科術后氣管拔管反應的臨床研究. 南寧: 廣西醫科大學, 2008.
16. 曹觀海. 可實施表面麻醉的氣管插管的制作與臨床應用. 長春: 吉林大學, 2013.
17. 陳窈麗, 張天偉. 利多卡因對氣管拔管心血管反應的作用及護理觀察. 中國實用醫藥, 2013, 8(24): 236-238.
18. 朱磊, 姜鳳鳴, 金立民, 等. 利多卡因靜脈注射用于減輕全麻氣管拔管時心血管應激反應的臨床研究. 中國實驗診斷學, 2013, 17(4): 731-732.
19. 傅國強, 王蘭, 李連紅. 利多卡因不同給藥方法對全麻蘇醒拔管時血流動力學變化的影響. 臨床麻醉學雜志, 2007, 23(1): 72-73.
20. 原皓, 鄒亮. 靜脈注射利多卡因復合頭抬高位對拔管引起的血流動力學改變及嗆咳反應的影響. 中國醫刊, 2017, 52(12): 82-85.
21. 李榮, 張中軍, 毛洪雅, 等. 羅哌卡因與利多卡因氣道表面麻醉對氣管插管及拔管反應影響的比較. 臨床麻醉學雜志, 2016, 32(5): 504-505.
22. 覃寶全. 前列腺素E_1預防全麻氣管內插管心血管副反應的觀察. 右江民族醫學院學報, 2000, 22(6): 924-925.
23. 劉志雙, 孟慶云, 柳順鎖, 等. 前列腺素E_1預防全麻氣管內插管心血管副反應的觀察. 中華麻醉學雜志, 1999, 19(5): 22-25.
24. 唐世美, 彭章龍, 于布為. 尼卡地平、拉貝洛爾和利多卡因預防全麻拔管心血管反應的比較. 臨床麻醉學雜志, 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. 時勝男, 左明章, 李曉琳. 術中靜脈輸注利多卡因對老年患者全麻下非心臟手術后認知功能的影響. 中華麻醉學雜志, 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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