الفهرس 
Introduction and rationaleOnly 14 pages are availabe for public view
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Abstract
This study was designed to evaluate the anti-inflammatory and pulmonary protective effects of intravenous lidocaine infusionin reducing the incidence of postoperative pulmonary dysfunction and complications in 54 patients undergoing Coronary artery bypass graft surgeries,After induction of Anaesthesia, patients were assigned to either receive lidocaine or saline ,The lidocaine infusion was maintained throughout the surgical procedure and discontinued at the end of surgery. Patients in the control group received an i.v. bolus of normal saline, followed by a continuous infusion of saline during surgery, at the same volume and rate as the lidocaine group.
The current study demonstrated that systemic lidocaine infusion has a role in reducing the inflammatory process post cardiopulmonary bypass which was detected through reduced level of raised interleukins 6 ,8 and neutrophil elastase.
Intra-operative levels of interleukin 6 was significantly lower in the lidocaine group 5 minutes after cross clamping (84.68±29.36ug/ml) when compared to the control group (127.89 ± 34.18 ug/ml).Similarly postoperative levels of interleukin 6 at 24 hours (321.73 ± 86.83 ug/ml) and 48 hours interval ( 279.76 ± 69.91 ug/ml) were significantly lower in the lidoacine group when compared to the control group (436.13 ± 129.85 ug/ml) at 24 hour interval postoperative and(339.41 ± 93.99 ug/ml) at 48 hours respectively (P value < 0.05).
Intra-operative levels of interleukin 8 was significantly lower in the lidocaine group 5 minutes after cross clamping (5.34 ± 7.48ug/ml) when compared to the control group (39.59 ± 27.51 ug/ml) .
Similarly postoperative levels of interleukin 8 at 24 hours (5.56 ± 7.55 ug/ml) and 48 hours interval (2.00 ± 4.98 ug/ml) were significantly lower in the lidoacine group when compared to the control group (11.22 ± 10.41 ug/ml) at 24 hour interval postoperative and(6.15 ± 8.08 ug/ml) at 48 hours respectively (P value < 0.05).
Intra-operative levels of neutrophilelastase was significantly lower in the lidocaine group 5 minutes after cross clamping (26.39 ± 9.73ng/ml) when compared to the control group (183.78 ± 50.36 ng/ml) .
Similarly postoperative levels of neutrophil elastase at 24 hours (62.19 ± 29.55ng\ml) and 48 hours interval (41.85 ± 19.31ng\ml) were significantly lower in the lidoacine group when compared to the control group (159.26 ± 50.76ng\ml) at 24 hour interval postoperative and (115.96 ± 38.97ng\ml) at 48 hours respectively (P value < 0.05).
Regarding time of extubation, There was statistically significant difference at time of extubation in the lidocaine group with a mean of 131.1 min± 64.5 compared to a mean of 542.2± 146.5 minutes(p-value 0.000). 11 %of the lidocaine group needs re-intubation, all of them for hemodynamic instability , with no statistically significant difference. Time of re-intubation was 180±45 min postextubation, patients were transfered immediately to the operative theatre Exploration was done and reveal surgical causes of bleeding and patients were transferred to the cardiothoracic intensive care unit intubated .
There was statistically significant difference in the alveolar arterial gradient difference from base line between the lidocaine and control group in favor of the lidocaine group 40.7% of the lidocaine group had less than 10 % increase in the A-a gradient from baseline corresponding to 11.1 % in the control group .
Yet 59.3% of the lidocaine group had more than 10 % increase in the A-a gradient from base line compared to 88.9 of the control group (p-value 0.014).
• The current study has the following limitation
Although the number of study patients was large enough to detect a difference in inflammatory biomarkers , we cannot exclude that the number was small to demonstrate pulmonary dysfunction as assessed by A-a gradient,chestxray,and oxygenation index.
Spirometry was not done post extubation neither on discharge to be able to compare between baseline spirometry and postoperative one in both groups ,this was another factor that could explain difficulty in eliciting a statistically significant difference regarding postoperative pulmonary dysfunction.
from this study we recommend the following:
To use intravenous lidocaine infusion to reduce inflammatory response in patients undergoing onbypass coronary artery graft surgery