Abstract
Higher incidence and worse outcomes of laryngospasm during general anesthesia in children than adults have been reported for many years, but few prevention measures are put forward. Efficacy of lidocaine in laryngospasm prevention has been argued for many years and we decided to design this network meta-analysis to assess the efficacy of lidocaine. We conducted an electronic search of six sources and finally included 12 Randomized Controlled Trials including 1416 patients. A direct comparison between lidocaine and placebo revealed lidocaine had the effect on preventing laryngospasm in pediatric surgery (RR = 0.46, 95% CI = [0.30, 0.70], P = 0.0002, I2 = 0%). Both subgroup analysis and network analysis demonstrated that both intravenous lidocaine (subgroup: RR = 0.39, 95% CI = [0.18, 0.86], P = 0.02, I2 = 38%; network: RR = 0.25, 95% CI = [0.04, 0.86]) and topical lidocaine (subgroup: RR = 0.37, 95% CI = [0.19, 0.72], P = 0.003, I2 = 0%; network: RR = 0.14, 95% CI = [0.02, 0.55]) was effective in laryngospasm prevention, while no statistical difference was found in a comparison between intravenous and topical lidocaine. In conclusion, both intravenous and topical lidocaine are effective in laryngospasm prevention in pediatric surgery, while a comparison between them needs more evidences.
Highlights
Since the laryngospasm were judged by professional medical workers, we judged that the outcome measurement was at low risk to be influenced even when no blinding set
The network comparisons and direct comparisons both indicated that both topical lidocaine and intravenous lidocaine could lower the risk of laryngospasm during general anesthesia in children, while there were no sufficient studies to compare the effect between intravenous and topical lidocaine
Different from Mihaha et al.[19], we took laryngospasm events as 11 in lidocaine group and 11 in placebo group in Leicht et al.[3], because the definition of laryngospasm we defined here equaled to a combination of “stridor”, “occlusion” and “cyanosis” in Leicht et al.[3]
Summary
A meta-regression analysis was conducted using Stata (version 12.0) including the following covariates: type of surgery (tonsillectomy or adenoidectomy vs others), Anesthetic gas (isoflurane vs others), airway device (tracheal tube vs laryngeal mask airway), route of administration (intravenous vs topical), timing of administration (before extubation vs before intubation), definition of laryngospasm (undefined vs mixed vs accurate) and blinding of outcome assessment (low risk vs unclear and high risk). When excluding each study one by one for sensitivity, we got similar results for the outcome in all direct comparisons in fixed effect model, and in lidocaine vs placebo group and topical lidocaine vs placebo group in random effect model, but not in intravenous lidocaine vs placebo group in random effect model.
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