Critical Care Research and Practice / 2015 / Article / Tab 2

Review Article

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

Table 2

Lidocaine treatment characteristics and ICP response.

ReferenceLidocaine doseMean duration of lidocaine administration (days)ICP responseOther primary/secondary outcomesAdverse effects to lidocaineConclusions

Bedford et al. [6]1.5 mg/kg IV bolus x1 ()
Thiopental dose () = 3 mg/kg IV x1
Single bolus doseLidocaine: decrease in mean ICP from 28 mm Hg to 13 mm Hg, with nadir reached at a mean 66 ± 10 sec
Thiopental: decrease in mean ICP from 33 mm Hg to 14 mm Hg, with a nadir reached at a mean 48 ± 9 sec
Mean MABP decrease of 26 mm Hg with thiopental
No MABP changes with lidocaine
None describedLidocaine and thiopental are equally an effect in reduction of ICP via IV bolus, with lidocaine preserving systemic hemodynamics

Bedford et al. [7]1.5 mg/kg IV bolus x1 ()
Saline () = same volume
Single bolus dosePretreatment with IV lidocaine led to a maximum mean ICP increase of 6 mm Hg and 4 mm Hg at 30 and 60 sec
Saline placebo mean increase in ICP of 16 mm Hg and 13 mm Hg at 30 and 60 sec
MABP increase was less with lidocaine compared to placeboNone describedIV lidocaine during laryngoscopy leads to an attenuation of ICP elevation compared to saline.

Donegan and Bedford [8]1.5 mg/kg IV bolus x1
Saline was given in the same volume as lidocaine  Patients received both therapies
Single bolus doseLidocaine presuction led to a mean increase in ICP of 3.4 ± 6.2 mm Hg and 1.8 ± 2.6 mm Hg in those on and off barbiturates during suctioning
Saline placebo presuction led to a mean increase in ICP 19 ± 4.7 mm Hg and 5.7 ± 3.2 mm Hg in those on and off barbiturates during suctioning
No significant difference in MABP changes during suctioningNone describedLidocaine presuctioning leads to an attenuation of ICP elevations compared to saline

Donegan et al. [9]1.5 mg/kg IV bolus x1
Saline was given in the same volume as lidocaine  Patients received both therapies
Single bolus doseLidocaine pretreatment led to a significant attenuation in ICP elevation with suctioningNot statedNone describedLidocaine presuctioning leads to an attenuation of ICP elevations compared to saline

Grover et al. [10]Three groups:
Group 1 (): 1 mg/kg IV bolus x1
Group 2 (): 1.5 mg/kg bolus x1
Group 3 (): 2 mg/kg bolus x1
Single bolus doseAll groups displayed a significant decrease in ICP within 2 min of lidocaine administration
Group 3 displayed a 37.5% reduction in mean ICP, and Group 1 displayed a 17.5% mean reduction
Group 3 was the only group to display significant drop in SBPSBP decreased with 2 mg/kg IV bolus doseIV lidocaine bolus leads to significant reductions in ICP High lidocaine dosing may lead to drops in SBP

Hamill et al. [11]LT (): 4 mL 4% lidocaine endotracheal
IV (): 1.5 mg/kg IV bolus x1
Single doseIV lidocaine led to a significant decrease in baseline ICP with no elevations during laryngoscopy
LT lidocaine failed to decrease ICP and all patients had a significant elevation in ICP during intubation
Significant HR and MABP increase in LT groupNone describedIV lidocaine led to decrease in baseline ICP and attenuated ICP elevations during laryngoscopy

Hirayama et al. [12]All had dexamethasone and glycerin, with this therapy in isolation.
Lidocaine (): 10% lidocaine continuous infusion at 1.5–3 mg/min
Nitroglycerine (): 3–7 mcg/kg/min
Continuous infusionThe addition of lidocaine to glycerin therapy led to a reduction in ICP spikes, with a mean reduction in ICP of 8.9 mm Hg over 24 hours
The addition of nitroglycerin to glycerin led to a mean reduction of ICP of 7.4 mm Hg over 24 hours
Not statedNone describedBoth IV lidocaine and nitroglycerin in the presence of glycerin therapy lead to ICP reductions at 24 hours

Montarry et al. [13]All patients underwent suctioning without lidocaine, then with IV, and finally with LT
Lidocaine IV: 1.5 mg/kg of 2% lidocaine bolus x1 Lidocaine LT: 5% lidocaine
Single doseNo difference in the ICP over 6 min for no lidocaine, or either of the lidocaine routes, during suctioning.
10 patients had documented ICP > 20 mm Hg and had the same lidocaine treatment
Lidocaine IV led to a mild reduction in ICP over 6 min by approx. 2 mm Hg LT lidocaine did not have any significant effect compared to baseline
No difference in CPPNot describedLidocaine IV or LT did not lead to a suppression of ICP during suctioning
Lidocaine IV bolus during acute ICP elevations may lead to mild reduction in ICP.

Samaha et al. [14]Lidocaine: 1.5 mg/kg IV x1
Esmolol: 1.5 mg/kg IV x1
Single dosePostintubation ICP rose significantly in both groups
Esmolol: increased from 11 ± 6 mm Hg to 17 ± 10 mm Hg
Lidocaine: increased from 10 ± 6 mm Hg to 16 ± 9 mm Hg
Significant decrease in CPP in both groups during intubation
Esmolol decreased from a mean of 92 to 62 mm Hg  Lidocaine decreased from a mean of 96 to 68 mm Hg 
After intubation
CPP increased to 99 ± 23 mm Hg and 99 ± 17 mm Hg in the esmolol and lidocaine groups
Not describedBoth lidocaine and esmolol failed to attenuate the elevation in CPP and ICP after intubation

White et al. [15]Every patient received all treatments during individual suctioning episodes
Saline = 2 mL
Fentanyl = 1 mcg/kg
Thiopental = 3 mg/kg
Lidocaine = 1.5 mg/kg + succinylcholine = 1.5 mg/kg
Lidocaine LT alone = 1.5 mg/kg
Single bolus doseLidocaine/succinylcholine IV and thiopental lead to a mean decrease in ICP by 4–6 mm Hg but had no effect on the ICP during suctioning
LT lidocaine had more effect at attenuating cough and ICP elevations during suctioning. However, during instillation it initiated coughing and led to ICP spikes
Fentanyl had no effect on ICP
MABP not affected by any regimenNone describedLidocaine IV leads to ICP reduction but not attenuation of cough mediated ICP spikes
LT lidocaine may be superior in preventing coughing related ICP spikes

Yano et al. [16]1.5 mg/kg IV bolus dose at the following intervals prior to suctioning: 1, 3, 5, 10, and 15 min
LT lidocaine = 2 mL of 4% lidocaine across the same intervals
Single bolus dosesNeither IV of LT lidocaine lowered baseline ICP, but both suppressed ICP elevations with suctioning
LT lidocaine led to a lower peak ICP compared to IV
Not statedNone describedBoth IV and LT lidocaine suppress ICP elevations during suctioning

= number of patients, mg = milligram, mcg = microgram, mL = milliliters, wt = weight, kg = kilogram, hr = hour, min = minute, 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.