Objective: Propofol for procedural sedation and analgesia (PSA) for colonoscopy can result in a high prevalence of severe respiratory depression. Studies have shown that intravenous (IV) infusion of lidocaine can reduce propofol requirements significantly and increase the ventilatory response to carbon dioxide in humans. We tested the hypothesis that IV lidocaine could improve propofol-induced respiratory depression in obese patients during colonoscopy.
Methods: Ninety obese patients scheduled for painless colonoscopy were randomized to receive lidocaine (1.5 mg/kg, then 2 mg/kg/h, IV) or the same volume of 0.9% saline. Intraoperative sedation was provided by propofol. The primary outcome was the number of oxygen-desaturation episodes. Secondary outcomes were: the number of apnea episodes; total propofol consumption; time to the first hypoxia episode; time to consciousness loss; intraoperative hemodynamic parameters; awakening time; adverse events; duration of post-anesthesia care unit (PACU) stay; satisfaction of endoscopists and patients.
Results: Demographic characteristics between the two groups were comparable. The number of oxygen-desaturation episodes in group L (1.49± 1.12) decreased by 0.622 (P=0.018) compared with that in group N (2.11± 1.32), and the number of apnea episodes in group L decreased by 0.533 (P< 0.001). Kaplan–Meier curves showed that the median time to the first hypoxia episode was longer in group L (86.78 s) than that in group N (63.83 s) (Log rank P=0.0008). The total propofol consumption, awakening time, and duration of PACU stay were reduced in group L. There was no significant difference in the prevalence of adverse events (P> 0.05 for all). Satisfaction scores for endoscopists and patients in group L were higher than that in group N (P< 0.001).
Conclusion: Intravenous infusion of lidocaine could significantly reduce the number of oxygen-desaturation and apnea episodes in obese patients during painless colonoscopy. This method is worthy of clinical promotion.
Clinical Trials Registration: ChiCTR2000028937.

Keywords: lidocaine, propofol, obese patients, colonoscopy


中文翻译：

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静脉注射利多卡因在接受无痛​​结肠镜检查的肥胖患者中的应用：一项前瞻性、随机、双盲、对照研究。

目的：丙泊酚用于结肠镜检查的程序性镇静和镇痛（PSA）可导致严重呼吸抑制的高患病率。研究表明，利多卡因的静脉内 (IV) 输注可以显着降低丙泊酚的需求并增加人体对二氧化碳的通气反应。我们检验了以下假设：IV 利多卡因可以改善结肠镜检查期间肥胖患者丙泊酚引起的呼吸抑制。
方法：90 名计划进行无痛结肠镜检查的肥胖患者随机接受利多卡因（1.5 mg/kg，然后 2 mg/kg/h，IV）或相同体积的 0.9% 生理盐水。术中使用丙泊酚进行镇静。主要结果是氧饱和度下降的次数。次要结果是：呼吸暂停发作次数；异丙酚总消耗量；第一次缺氧发作的时间；意识丧失的时间；术中血流动力学参数；觉醒时间；不良事件; 麻醉后护理病房 (PACU) 的停留时间；内镜医师和患者的满意度。
结果：两组之间的人口统计学特征具有可比性。L组氧饱和度下降次数（1.49±1.12）减少0.622（P=0.018）与N组（2.11±1.32）相比，L组呼吸暂停次数减少0.533（P < 0.001）。Kaplan-Meier 曲线显示，L 组第一次缺氧发作的中位时间（86.78 秒）比 N 组（63.83 秒）长（对数秩P = 0.0008）。L组丙泊酚总用量、苏醒时间和PACU停留时间均减少，不良事件发生率差异无统计学意义（均P >0.05）。L组内镜医师及患者满意度评分均高于N组（P <0.001）。
结论：在无痛结肠镜检查期间，静脉输注利多卡因可显着减少肥胖患者的氧饱和度下降和呼吸暂停发作次数。该方法值得临床推广。
临床试验注册： ChiCTR2000028937。

关键词：利多卡因，丙泊酚，肥胖患者，结肠镜检查