Opioid-based Versus Lidocaine-based Induction of Anesthesia With Propofol in Elderly
Status:
Not yet recruiting
Trial end date:
2022-01-01
Target enrollment:
Participant gender:
Summary
Advances in the medical service and public health increased longevity; hence, more elderly
patients (>65 years) are encountered by the anesthetists for variety of surgical
interventions. Even with the absence of comorbidity, older patients represent a challenge to
the anesthetist in comparison to the younger patients due to their limited physiologic
reserve and their aberrant response to the varies perioperative medications.
Intraoperative hypotension increases the risk of postoperative kidney injury, myocardial
injury, cerebral ischemia, and perioperative mortality. Postinduction hypotension is mainly
caused by anesthetic drugs. Hence, developing a technique for induction of anesthesia that
provide adequate hypnosis with stable hemodynamics during surgery is critical, especially for
elderly patients. The elderly patients are at increased risk of post-induction hypotension
due to increased drug sensitivity.
Propofol is the most commonly used drug for anesthesia induction; however, its use is usually
associated with hypotension through vasodilation and direct myocardial depression. Opioid
drugs are usually added as analgesics to propofol during induction of anesthesia. However,
addition of opioids to propofol potentiates the risk of postinduction hypotension.
Furthermore, opioids increase the risk of postoperative delirium in elderly patients and this
risk is further increased with intraoperative hypotension.
Lidocaine is a local anesthetic drug with multiple systemic uses. Lidocaine was proposed to
have an anesthetic sparing effect. Lidocaine was previously reported to enhance the hypnotic
effect of thiopentone, propofol, and midazolam during procedural sedation. Lidocaine/ketamine
combination showed favorable hemodynamic profile following rapid-sequence induction of
anesthesia in septic shock patients. Therefore, the use of lidocaine as an adjuvant to
propofol might provide a stable cardiovascular profile during induction of anesthesia in
elderly compared to fentanyl. To the best of our knowledge, there is no previous data
comparing the efficacy of adding lidocaine versus fentanyl to the induction of anesthesia
with propofol in elderly