Myocardial injury after noncardiac surgery (MINS) is the most common perioperative cardiovascular complication affecting up to 8 million adults worldwide annually. Patients who suffer MINS are at increased risk of postoperative mortality and major non-fatal cardiovascular complications with this elevated risk persisting well beyond the early postoperative period. The perioperative physiological and pathophysiological processes that are thought to contribute to the myocardial ischaemia that result in MINS include the perioperative stress response, haemodynamic instability, bleeding and clotting disturbances. These interrelated processes represent potential avenues for the treatment or prevention of MINS.

 

Lidocaine is an amide local anaesthetic in widespread use worldwide. When administered intravenously, lidocaine has a wide therapeutic margin and its safety is well supported. In addition to its recognised analgesic and antiarrhythmic properties it has been shown to exert pleiotropic anti-inflammatory effects as well as cardioprotective effects against myocardial ischaemia and reperfusion injury.

 

A substudy of 105 patients in the VAPOR-C Feasibility Study compared patients who received intravenous lidocaine administered at a dose greater than 1mg.kg-1 during major cancer surgery to those that did not. This small unrandomised sample showed a significant reduction in MINS and markers of inflammation in patients that received lidocaine when compared to those that did not. This supports the plausibility that perioperative inflammation is implicated in the pathogenesis of MINS and that lidocaine may have a role in reducing the incidence of MINS.

 

The VAPOR-C Trial provides the optimal environment in which to study the impact of lidocaine on MINS in a randomised control trial. The MINS in VAPOR-C Trial will be run as a sub-study of the main VAPOR-C Trial at participating sites.