Effects of aerosolized lidocaine on circulatory responses to laryngoscopy and tracheal intubation: Venus B, Polassani V, Pham CG Crit Care Med 12:391–394 Apr 1984

✍ Scribed by Richard C Dart

• Publisher: Elsevier Science
• Year: 1984
• Tongue: English
• Weight: 105 KB
• Volume: 13
• Category: Article
• ISSN: 1097-6760
• DOI: 10.1016/s0196-0644(84)80690-3

✦ Synopsis

The authors evaluated the effectiveness of aerosolized lidocaine in preventing the hypertension and tachyarrhythmias associated with laryngoscopy and endotracheal intubation. The study included 19 adult cancer patients scheduled for general anesthesia who had no history of hypertension, myocardial insufficiency, or cerebral vascular disease. After premedication with atropine 0.05 mg/kg and morphine 1 mg/kg, baseline ECG and intraarterial blood pressure were monitored. The patients were then randomly divided into Group I (10 patients who received normal saline by aerosol for 5 minutes during preoxygenation )before induction of anesthesia]), or Group II (nine patients who received aerosolized 4% lidocaine for 5 minutes during preoxygenation). The aerosolized medications were administered in a double-blind manner. All patients then received intravenous thiopental and succinylcholine, face mask ventilation with nitrous oxide, followed by direct laryngoscopy and intubation using a Macintosh blade. Laryngoscopy was intentionally prolonged for a total of at least 60 seconds in all patients. Data were analyzed using a two-way analysis of variance and mean values compared using the least significant difference test. The groups were not statistically different with regard to multiple parameters, including age, duration of laryngoscopy, and resting vital signs. Neither group changed after premedication. Induction of anesthesia signif-ic~intly reduced systolic, mean, and diastolic blood pressures in both groups. During laryngoscopy and intubation, blood pressures and heart rates increased significantly in the saline group and remained elevated for more than 5 minutes. The patients who received aerosolized lidocaine showed no significant increases in heart rate or blood pressure during laryngoscopy and intubation. The incidence of arrhythmias during intubation and 5 minutes postintubation was higher in the aerosolized saline group. After briefly describing the disadvantages of other techniques that have been used to modify the pressor response to intubation, the authors advise the use of their technique in intubating patients with borderline cardiovascular status.