The Impact of Intravenous Lidocaine on ICP in Neurological Illness: A Systematic Review

Table 1

Study characteristics and patient demographics.

Reference	Number of patients	Study type	Article location	Mean age (years)	Patient characteristics	Primary and secondary goal of study
Bedford et al. [6]	20; Lidocaine (); Thiopental ()	Prospective nonrandomized	Manuscript	Lidocaine = 51.1 ± 4.4; Thiopental = 47.5 ± 5.0	Brain tumors undergoing elective resection having sustained ICP elevations for >30 sec after induction; Anesthetic: thiopental, nitrous oxide/O2, and morphine	Primary: to determine the effect of IV lidocaine versus thiopental on ICP control for sustained ICP elevations; Secondary: none stated
Bedford et al. [7]	20; Lidocaine (); Placebo ()	Prospective randomized control trial	Meeting abstract	Lidocaine = 49 ± 6; Placebo = 55 ± 6	Brain tumors undergoing elective resection; Anesthetic: thiopental, nitrous oxide/O2, and morphine	Primary: to determine the effect of IV lidocaine versus saline (at induction) on ICP during laryngoscopy; Secondary: none stated
Donegan and Bedford [8]	10	Prospective cohort	Manuscript	Unknown	Severe TBI with ICP > 20 mm Hg during suctioning; Concurrent ICP therapy: hyperventilation (pCO2 goal 30 mm Hg), mannitol, dexamethasone, and pentobarbital ()	Primary: to determine the effect of IV lidocaine versus saline on ICP during suctioning; Secondary: not stated
Donegan et al. [9]	9	Prospective cohort	Meeting abstract	Unknown	Severe TBI with ICP > 20 mm Hg during suctioning; Concurrent ICP therapy: hyperventilation (pCO2 goal 30 mm Hg), mannitol, dexamethasone, and pentobarbital ()	Primary: to determine the effect of IV lidocaine versus saline on ICP during suctioning; Secondary: not stated
Grover et al. [10]	30	Prospective randomized trial	Manuscript	Age > 5 years	Clinically raised ICP and undergoing VPS surgery; Anesthetic: thiopental induction with suxamethonium NMBA; Maintenance with 66% nitrous oxide/oxygen mix, pancuronium, and morphine	Primary: to determine the effect of different IV lidocaine doses on ICP; Secondary: not stated
Hamill et al. [11]	22; LT Lidocaine (); IV Lidocaine ()	Prospective randomized trial	Manuscript	Unknown	Brain tumors undergoing elective resection; Anesthetic: thiopental, succinylcholine, and 50% nitrous oxide/oxygen mix	Primary: to determine effect of LT versus IV lidocaine on ICP during laryngoscopy; Secondary: HR and MABP
Hirayama et al. [12]	21 patients; Steroid/glycerin (); Steroid/glycerin/lidocaine (); Steroid/glycerin/nitroglycerin ()	Prospective nonrandomized	Meeting abstract	Unknown	“Postoperative” neurosurgery patients; Concurrent ICP therapy: dexamethasone 5–10 mg TID, glycerin 200 gm/day	Primary: to determine the effects of IV lidocaine versus nitroglycerin on ICP; Secondary: not stated
Montarry et al. [13]	20	Prospective cohort	Manuscript	32	Severe TBI; Concurrent ICP therapy: thiopental, maintained negative fluid balance, pCO2 goal 28 mm Hg	Primary: to determine the effects of IV versus LT lidocaine on ICP control during endotracheal suctioning; Secondary: cerebral perfusion pressure
Samaha et al. [14]	22; Esmolol (); Lidocaine ()	Prospective randomized trial	Manuscript	Esmolol: 50 ± 13; Lidocaine: 47 ± 16	Elective neurosurgical patients (tumors and aneurysm clippings); ICP measured via LD  Anesthetic: thiopental induction, sevoflurane, maintenance, pCO2 goal 33–35 mm Hg	Primary: to determine the effect of esmolol versus lidocaine IV bolus (130 sec before intubation) on lumbar cistern pressures during laryngoscopy (ICP measured before, during, and 2 and 5 min after intubation); Secondary: MABP, CPP
White et al. [15]	15	Prospective cohort	Manuscript	Unknown	Severe TBI with elevations of ICP > 20 mm Hg during or immediately after suctioning; Concurrent ICP therapy: sedation with diazepam and morphine, hyperventilation (pCO2 25–30 mm Hg)	Primary: to determine the effects of different pretreatment (saline, fentanyl, thiopental, lidocaine, and succinylcholine) on ICP during suctioning; Secondary: MABP
Yano et al. [16]	9	Prospective cohort	Manuscript	34.6 (range: 16 to 71)	Severe TBI; Concurrent ICP therapy: not specific, hyperventilated to pCO2 goal of 25 to 30 mm Hg	Primary: to determine the effect of IV and LT lidocaine on ICP during suctioning; Secondary: not stated

= number of patients, HR = heart rate, MABP = mean arterial blood pressure, ICP = intracranial pressure, CPP = cerebral perfusion pressure, CSF = cerebrospinal fluid, mm Hg = millimeters of mercury, IV = intravenous, LT = laryngotracheal, TBI = traumatic brain injury, LD = lumbar drain, and sec = second. Donegan and Bedford [8] and Donegan et al. [9] are companion publications, with Donegan et al. [9] representing the meeting abstract published prior to the full manuscript [8]. The data from Donegan et al. [9] is not included in the synthesis of data and is only included in the tables for completeness.