Lidocaine mitigates cognitive decline in elderly patients after video-assisted thoracoscopic surgery: A double-blind randomized controlled clinical trial

• Postoperative cognitive decline could occur in elderly patients after lung surgery • Intraoperative lidocaine infusion could mitigate postoperative cognitive decline • Intraoperative lidocaine infusion could mitigate inflammatory responses after surgery • Intraoperative lidocaine infusion could improve brain oxygenation after surgery : Postoperative cognitive decline (POCD) can occur in elderly patients after surgery and is associated with poor outcomes. Lidocaine is an antiarrhythmic and anesthetic agent, with analgesic and anti-inflammatory properties. We aimed to explore the influence of lidocaine on POCD in elderly patients undergoing video-assisted thoracoscopic lobectomy. : This was a prospective double-blind randomized controlled clinical trial performed between January 2022 and August 2024. Eligible patients ≥ 65 years old scheduled for video-assisted pulmonary lobectomy under general anesthesia with one-lung ventilation were randomized into lidocaine (1.5 mg/kg lidocaine at anesthesia induction followed by continuous intravenous infusion at 1.5mg/kg/hr) or control (same dose of normal saline) group. Mini-Mental State Examination (MMSE), serum IL-6 and S100β levels, and cerebral oxygen extraction rate (CREO 2 ) were measured before and after surgery. : A total of 80 patients, with 40 patients in each group, completed the trial. Compared with pre-operation, MMSE scores in control group were significantly decreased on postoperative days 1 and 3 (P < 0.05), which was mitigated in lidocaine group. Serum IL-6 and S100β levels were significantly increased in control group on postoperative days 1 and 3 (P < 0.05), which was also mitigated in lidocaine group. In addition, CERO 2 was significantly increased in 30 and 60 min after initiation of one-lung ventilation in control group (P < 0.05), which was also mitigated in lidocaine group. : Lidocaine could mitigate cognitive decline after video-assisted thoracoscopy with one-lung ventilation. Its effect might be related to anti-neuroinflammation and reduced cerebral oxygen metabolic rate.