Cardioprotection in thoracic oncosurgery: phosphocreatine or lidocaine

Objective. To evaluate the cardioprotective properties of phosphocreatine compared to lidocaine in patients with concomitant cardiovascular diseases (CVD) based on the analysis of the dynamics of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels and early postoperative complications in thoracic oncosurgical interventions. Material and methods. The study analyzed the course of anesthesia and the early postoperative period in 71 patients aged 56—79 years with concomitant CVD who underwent thoracic interventions for localized non-small cell lung cancer. Patients were randomized into two comparable groups: in the lidocaine group (Group 1, n=35), a 2% lidocaine solution was administered intravenously intraoperatively (bolus + infusion via an infusion pump), and in the phosphocreatine group (Group 2, n=36), patients received creatine phosphate on the day before, on the day of the surgery, and for 3 days in the postoperative period. The dynamics of NT-pro-BNP levels (before skin incision, on days 1 and 3) and early cardiovascular complications were assessed. Results. There were no differences in baseline NT-pro-BNP levels between the study groups (p=0.298), and no significant differences were observed on the day 1 post-op (p=0.331). Group 1 showed significantly lower levels of the biomarker on the day 3 in the postoperative period (p=0.011). In the early postoperative period, Group 1 had fewer complications than Group 2 (1 vs. 4); p=0.359. Factors directly associated with the occurrence of complications were the maximum intraoperative heart rate (p=0.013). Patients who developed complications had significantly higher levels of NT-pro-BNP on the day 3 of the postoperative period (p=0.006). Conclusion. Based on the results of this study, lidocaine exhibits more pronounced cardioprotective properties when used as an adjuvant agent in anesthesia during surgical interventions in patients with oncothoracic profiles and concomitant CVD.