title: Cognitive deficit in first-time coronary artery bypass graft patients: a randomized clinical trial of lidocaine versus procaine hydrochloride.
abstract: BACKGROUND
  Cognitive dysfunction increasingly has been recognized as a complication after cardiac surgery. Different methods have been considered for the reduction of cognitive dysfunction after cardiac surgery. One of these methods is by using lidocaine during surgery. The aim of this study was to determine the effects of adding lidocaine to the cardioplegia solution on cognitive impairment after coronary artery surgery.
  
  
  METHODS
  In a prospective, randomized, double-blind trial, 110 patients aged between 20-70 years, scheduled for elective CABG surgery using cardiopulmonary bypass, were recruited into the study. They were randomized into two groups who received either cardioplegia solution containing lidocaine 2 mg/kg or procaine hydrochloride 5 mg/kg. The neurocognitive test used in this study was the Mini Mental State Examination (MMSE) or Folstein test. The test was done on the day before and 10 days and 2 months after the operation.
  
  
  RESULTS
  In the procaine group, the total score after 10 days decreased significantly compared to the preoperative score (mean difference 0.68; 95% CI: 0.20 to 1.17, p=0.006). Comparison between mean differences after 10 and 60 days of operation between the lidocaine and procaine groups were statistically significant, p-value 0.017 and 0.013, respectively. There was no cognitive impairment in the lidocaine group, but, in the procaine group, four patients (7.7%) after 10 days and one patient (1.9%) after both 10 and 60 days had cognitive impairment, p=0.051.
  
  
  CONCLUSIONS
  Administration of lidocaine compared to that of procaine through the cardioplegia solution had a better effect on cognitive function after coronary artery bypass graft surgery.
authors.affiliation: Department of Cardiac Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: R
authors.initials: R
authors.lastname: Ghafari
authors.forename: A Gholipour
authors.initials: AG
authors.lastname: Baradari
authors.forename: A
authors.initials: A
authors.lastname: Firouzian
authors.forename: M
authors.initials: M
authors.lastname: Nouraei
authors.forename: M
authors.initials: M
authors.lastname: Aarabi
authors.forename: A
authors.initials: A
authors.lastname: Zamani
authors.forename: A
authors.initials: A
authors.lastname: Emami Zeydi
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D003071:Cognition / Q000187:drug effects*; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011343:Procaine / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D000779:Anesthetics, Local; D002314:Cardioplegic Solutions; D011343:Procaine; D008012:Lidocaine