Effects of Intravenous Lidocaine on Airway Complications and Hemodynamic Stability Following Emergency Laparoscopic Cholecystectomy: A Randomized Controlled Trial in Different Age Groups.

OBJECTIVES

This randomized controlled trial aimed to evaluate the effect of pre-extubation intravenous lidocaine (1 mg/Kg) on the incidence of airway complications and hemodynamic stability in patients undergoing emergency laparoscopic cholecystectomy, while accounting for age differences.

METHODS

The study was a prospective, single-center, randomized controlled trial conducted from 2021 to 2023 at Imam Khomeini Hospital, Ilam, Iran. Ninety patients undergoing emergency laparoscopic cholecystectomy were classified into two age groups (<50 and ≥50 years) and randomly assigned to receive either intravenous lidocaine (1 mg/Kg) or a standard extubation protocol. The primary outcomes included post-extubation airway complications, such as laryngospasm, cough, and sore throat, and the secondary outcomes included hemodynamic and respiratory parameters.

RESULTS

Lidocaine produced hemodynamic effects that differed by age group. In patients <50 years, systolic blood pressure (SBP) increased from 129.2±16.4 mmHg to 133.1±23.1 mmHg, while diastolic blood pressure (DBP) rose from 83.9±14.4 mmHg to 92.3±19.4 mmHg (both p<0.001). Conversely, in patients ≥50 years old, SBP decreased from 160.5±26.7 mmHg to 145.2±19.7 mmHg, and DBP decreased from 107.9±19.5 mmHg to 99.0±16.1 mmHg (both p<0.001). Airway complications exhibited non-significant tendencies, with a decreased incidence of cough in the older age group (15.6% vs. 31.8%) and an absence of laryngospasm in this age group. There were no serious adverse events (e.g., bronchospasm, arrhythmias).

CONCLUSION

Intravenous lidocaine was safe and demonstrated a trend toward reducing airway complications at extubation in patients undergoing emergency laparoscopic cholecystectomy, particularly in elderly patients. However, this trend did not reach statistical significance, most likely due to insufficient statistical power.