Original article
Adult cardiac
Cerebral Protection by Lidocaine During Cardiac Operations: A Follow-Up Study

https://doi.org/10.1016/j.athoracsur.2008.12.042Get rights and content

Background

A previous study showed less postoperative neurocognitive impairment in open-chamber cardiac surgery patients given lidocaine for 48 hours after induction of anesthesia. In the present study, we aimed to test the benefit of a 12-hour infusion in a broader group of cardiac surgery patients, including those undergoing coronary artery bypass graft surgery.

Methods

This was a randomized, double-blind, intention-to-treat trial. Before cardiac surgery, 158 patients completed 7 neurocognitive tests and a self-rating scale for memory. They received a 12-hour infusion of either lidocaine in a standard antiarrhythmic dose or placebo, beginning at induction of anesthesia. The cognitive tests and memory scale were repeated at postoperative weeks 10 and 25. A deficit in any cognitive test was defined as a decline in score by more than or equal to the preoperative group standard deviation.

Results

All tests were completed by 118 and 107 patients at 10 and 25 weeks, respectively. The proportions of patients in the lidocaine and placebo groups exhibiting a deficit in one or more tests were as follows: 45.8% versus 40.7% at 10 weeks, and 35.2% versus 37.7% at 25 weeks (not significant). There were no significant differences between groups in self-ratings of memory function or length of intensive care unit or hospital stay.

Conclusions

Lidocaine was not neuroprotective. The result of the previous trial may represent a type 1 error. Alternatively, benefit may be more likely for open-chamber surgery patients exposed to larger numbers of emboli or with a longer lidocaine infusion.

Section snippets

Patients and Methods

This study was conducted in the Departments of Cardiothoracic Surgery and Anesthesiology at Auckland City Hospital, Auckland, New Zealand, after Institutional Review Board approval. The format was a randomized, double-blind, controlled trial analyzed on an intention-to-treat basis. Eligible patients were 20 to 75 years old; resident in the greater Auckland area; English speakers as their first or preferred language; undergoing CABG (with or without cardiopulmonary bypass), valve surgery, or

Results

Recruitment numbers, treatment allocation, and losses to follow-up are documented in Figure 1. Recruitment of patients was dependent on the availability of a research associate trained to administer the neurocognitive tests. In addition, many patients failed to meet eligibility criteria (Fig 1), especially with respect to age, language, and place of residence. Throughout the study there were other trials concomitantly under way that competed for the same patient population, and our

Comment

There has been interest in lidocaine as a neuroprotective agent since the first relevant study demonstrated preservation of neuroelectrical function after cerebral arterial gas embolism in cats [12]. Subsequent studies spanning multiple animal models, injury types, and outcome measures were summarized in 2001 [4], and other studies have continued to emerge since then [13, 14, 15]. The overwhelming majority of studies conducted in carefully controlled experimental settings have demonstrated

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