Abstract
BackgroundTotal intravenous anesthesia (TIVA) with propofol and remifentanil is frequently used for pediatric cochlear implants (CIs) surgery as it does not suppress the electrical stapedial reflex threshold (ESRT). However, high doses of remifentanil exacerbate postoperative pain and increase opioid consumption. Intravenous lidocaine reduces pain and opioid requirement. This study investigated the effect of intravenous lidocaine on perioperative opioid consumption and ESRT in pediatric CIs.ResultsThe mean (95% CI) remifentanil consumption was significantly lower in lidocaine group than in placebo group [0.57 (0.497–0.643) vs 0.69 (0.63–0.75)] μg/kg/min, P = 0.016. The mean (95% CI) propofol consumption was significantly lower in lidocaine group than in placebo group [155.5 (146–165) vs 171 (161–181) μg/kg/min, P = 0.02. MBP and HR were significantly lower after surgical incision, laryngeal mask airway (LMA) removal, and at PACU admission in the lidocaine group compared with the placebo group. The PACU pain score was significantly lower in the lidocaine group compared to the placebo group. The mean (95% CI) pethidine consumption in PACU was significantly lower in the lidocaine group than in the placebo group 7.0 (6.17–7.83) vs. 8.9 (7.84–9.96) mg, P = 0.012. There were no differences between groups regarding ESRT response.ConclusionsIntravenous lidocaine infusion reduced perioperative opioid requirements without altering the ESRT in pediatric CIs.Trial registrationClinical registration number: NCT04194294.
Highlights
Total intravenous anesthesia (TIVA) with propofol and remifentanil is frequently used for pediatric cochlear implants (CIs) surgery as it does not suppress the electrical stapedial reflex threshold (ESRT)
Total intravenous anesthesia (TIVA) with propofol and remifentanil is frequently used for pediatric CIs as it does not suppress the ESRT
Remifentanil and propofol consumption were significantly lower in the lidocaine group compared to the placebo group (Table 2)
Summary
Total intravenous anesthesia (TIVA) with propofol and remifentanil is frequently used for pediatric cochlear implants (CIs) surgery as it does not suppress the electrical stapedial reflex threshold (ESRT). Recent studies found that intravenous (IV) lidocaine could be used as an adjuvant to TIVA without adversely affecting motor and sensory evoked potentials (Sloan et al 2014; Urban et al 2017) These studies have been done in adults undergoing spine surgeries. It has been shown that in children the cortical responses are more sensitive to anesthetics (Helmers and Hall 1994) It remains unclear whether systemic lidocaine can negatively affect ESRT in pediatric CIs
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