Critical Care Research and Practice / 2015 / Article / Tab 1

Review Article

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

Table 1

Study characteristics and patient demographics.

ReferenceNumber of patientsStudy typeArticle locationMean age (years)Patient characteristicsPrimary and secondary goal of study

Bedford et al. [6]20
Lidocaine () 
Thiopental ()
Prospective nonrandomizedManuscriptLidocaine = 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 trialMeeting abstractLidocaine = 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]10Prospective cohortManuscriptUnknownSevere 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]9Prospective cohortMeeting abstractUnknownSevere 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]30Prospective randomized trialManuscriptAge > 5 yearsClinically 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 trialManuscriptUnknownBrain 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 nonrandomizedMeeting abstractUnknown“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]20Prospective cohortManuscript32Severe 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 ManuscriptEsmolol: 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]15Prospective cohortManuscriptUnknownSevere 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]9Prospective cohortManuscript34.6 (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, mmHg = 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.