Impact of lidocaine on hemodynamic and respiratory parameters during laparoscopic appendectomy in children

We assessed the influence of systemic lidocaine administration on ventilatory and circulatory parameters, and the pneumoperitoneum impact on the cardiopulmonary system during a laparoscopic appendectomy in children. A single-center parallel single-masked randomized controlled study was carried out with 58 patients (3–17 years). Intravenous lidocaine bolus of 1.5 mg/kg over 5 min before induction of anesthesia followed by lidocaine infusion at 1.5 mg/kg/h intraoperatively. Respiratory system compliance (C, C/kg), P(peak)-PEEP and Pulse rate (Pulse), systolic, diastolic and mean blood pressure (NBP(s), NBP(d), NBP(m)), assessed in the Lidocaine and Control group, at the: beginning (P(1)), minimum lung compliance (P(2)) and at the end of surgery (P(3)) were compared. The respiratory/hemodynamic parameters did not differ between the groups at any stage of operation. Blood Pressure and P(peak)-PEEP were significantly higher at the P(2) compared to P(1) and P(3) stages (P < 0.001, 1 − β ≥ 0.895) that correlated with lung compliance changes: C/kg vs. NBP(s) and P(peak)-PEEP (− 0.42, − 0.84; P < 0.001); C vs. Pulse and P(peak)-PEEP (− 0.48, − 0.46; P < 0.001). Although an increase in intraabdominal pressure up to 12(15) mmHg causes significant changes in hemodynamic/respiratory parameters, there appears to be no risk of fatal reactions in 1E, 2E ASA patients. Systemic lidocaine administration doesn’t alleviate circulatory/respiratory alterations during pneumoperitoneum. No lidocaine related episode of anaphylaxis, systemic toxicity, circulatory disturbances or neurological impairment occurred. ClinicalTrials.gov: 22/03/2019. Trial registration number: NCT03886896.