| Objective:To evaluate the inhibitory effects of intravenous lidocaine and intratrachea on airway on hemodynamic and cough response in perioperative intubation and extubation during general anesthesia.Since it is still unclear whether the inhibitory effects of intravenous lidocaine or intratrachea local anesthesia on intubation and extubation response are better in the process of general anesthesia,a systematic review and meta analysis were performed for the literature included to assess the effectiveness and safety of different ways of lidocaine administration.Methods:The related articles regarding the inhibitory effects of intravenous lidocaine or intratrachea local anesthesia on stress response caused by endotracheal tube were retrieved in the English databases including Pub Med,Web of Science,Embase,and Cochrane Library and the Chinese ones including CNKI,VIP,Wanfang,and Sino Med from their establishment to the end of December 2022.Two researchers independently performed literature search and selected relevant data.Quality assessment and forest mapping were conducted for the articles that met the inclusion criteria with Rev Man5.4software.Heterogeneity and sensitivity were analyzed and publication bias was evaluated with Stata15.0 software.The primary outcome indicators were cough response at the moment of intubation or extubation,heart rate(HR),systolic blood pressure(SBP),and mean artery pressure(MAP).The secondary outcome indicators were diastolic blood pressure(DBP).Results:A total of 21 articles including 1,200 patients were incorporated.The results of m eta analysis showed that there was a statistical difference in cough response at the moment of intubation or extubation between intravenous lidocaine and intratrachea local anesthesia [OR=2.43,95%CI(1.45,4.06),P=0.0007]:there was a statistical difference in HR at the moment of intubation or extubation[MD=6.76,95%CI(2.94,10.57),P=0.0005].HR at 1 min:[MD=7.52,95%CI(1.24,13.81),P=0.02]and HR at 5 min[MD=4.90,95%CI(1.04,8.75),P=0.01]between intravenous lidocaine and intratrachea local anesth esia:there was a statistical difference in MAP at the moment of intubation or extubatio n [MD=5.04,95%CI(0.86,9.22),P=0.02],MAP at 1 min[MD=4.68,95%CI(0.23,9.12),P=0.04]MAP at 3 min[MD=5.52,95%CI(0.93,10.12),P=0.02]between intravenous lidoc aine and intratrachea local anesthesia;there was a statistical difference in SBP at the m oment of intubation or extubation[MD=7.29,95%CI(2.41,12.16),P=0.003] between int ravenous lidocaine and intratracheal local anesthesia and there was a statistical differe nce in DBP at the moment of intubation or extubation between intravenous lidocaine a nd intratrachea local anesthesia [MD=3.85,95%CI(0.94,6.77),P=0.010].Conclusion:Current evidence suggests that compared with intravenous lidocaine,intratrachea local anesthesia has a better inhibitory effect on stress response caused by endotracheal tube,which mainly reflects in hemodynamic fluctuation and cough response at the moment and 5min of intubation or extubation. |
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