title: Administration of lidocaine to prevent cognitive deficit in patients undergoing coronary artery bypass grafting and valve plasty: a systematic review and meta-analysis.
abstract: The administration of lidocaine to maintain cognitive function following coronary artery bypass grafting (CABG) and valve plasty is a controversial concept in terms of its effectiveness. We performed a systematic review to determine the effectiveness of treatment with lidocaine in preventing the occurrence of cognitive deficit after cardiac surgery. Area covered: To review the current literature on the subject, we searched the PubMed database and the Cochrane Library database (up to May 2015) and compiled a list of retrieved articles. Our final review includes only randomized controlled trials (RCTs) that compared lidocaine to a control (placebo) following CABG and valve plasty. Statistical analysis of the odds ratio (OR) and corresponding 95% confidence interval (CI) were used to determine the overall effectiveness of lidocaine for the prevention of cognitive deficit with both procedures. The Mantel-Haenszel method was used to pool data of the outcomes of cognitive deficit occurrence into fixed-effect model meta-analyses. Five RCTs were included in this study, with a total of 688 patients. Perioperative administration of lidocaine in patients undergoing cardiac surgery reduced occurrence of cognitive deficit (OR 0.583 [95% CI 0.438-0.777]; Z = -3.680; P = 0.00; I2= 52%). No significant difference in the early occurrence of cognitive deficit was revealed in patients after cardiac surgery (OR 0.909 [95% CI 0.600-1.376]; Z = -0.451; P = 0.652; I2= 11%). Expert commentary: Cognitive deficit associated with cardiac surgery is a common postoperative event. Lidocaine is contributed to a significantly reduced occurrence of cognitive deficit. Cognitive deficit management is recommended.
authors.affiliation: a Department of Anesthesiology, Faculty of Medicine , Mazandaran University of Medical Sciences , Sari , Iran.
authors.forename: Afshin
authors.initials: A
authors.lastname: Gholipour Baradari
authors.affiliation: a Department of Anesthesiology, Faculty of Medicine , Mazandaran University of Medical Sciences , Sari , Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Habibi
authors.affiliation: b Department of Cardiac Surgery, Faculty of Medicine , Mazandaran University of Medical Sciences , Sari , Iran.
authors.forename: Valiollah
authors.initials: V
authors.lastname: Habibi
authors.affiliation: b Department of Cardiac Surgery, Faculty of Medicine , Mazandaran University of Medical Sciences , Sari , Iran.
authors.forename: Seyed Mahmood
authors.initials: SM
authors.lastname: Nouraei
mesh_terms: D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects*; D003072:Cognition Disorders / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006801:Humans; D008012:Lidocaine / Q000494:pharmacology*; D061567:Voltage-Gated Sodium Channel Blockers / Q000494:pharmacology*
chemical_list: D061567:Voltage-Gated Sodium Channel Blockers; D008012:Lidocaine
keywords: Lidocaine; cognitive deficit; coronary artery bypass grafting; meta-analysis; valve plasty