A Comparison of the Endotracheal Tube and the Laryngeal Mask Airway as a Route for Endobronchial Lidocaine Administration

Abstract

Drug administration via the endotracheal tube is recommended as a second-line approach in emergency settings such as cardiac arrest. It is unknown what amount of drugs are absorbed when they are given through the laryngeal mask airway as compared with the endotracheal tube. We administered lidocaine at a dose of 2 mg/kg diluted in 10 mL normal saline to 20 anesthetized patients undergoing routine surgical procedures. Ten patients received lidocaine into the endotracheal tube and 10 patients received lidocaine into the laryngeal mask airway. Blood samples were taken for measurement of lidocaine plasma concentrations, and the pharmacokinetics were calculated. Therapeutic plasma concentrations (>1.4 microg/mL) could be achieved in 10 of 10 patients after endotracheal tube instillation but in only 4 of 10 patients after laryngeal mask instillation (P < 0.05). Peak lidocaine concentrations (2.47 and 1.09 microg/mL) (P < 0.05) and the area under the time versus plasma concentration curve (117.7 and 91.2 microg x min x mL(-1)) (P < 0.05) were higher after lidocaine administration into the endotracheal tube than into the laryngeal mask airway. In conclusion, the laryngeal mask airway is not a reliable route for the recommended dose of endobronchial lidocaine administration compared with the endotracheal tube.

A study on reducing the absorption of lidocaine from the airway in cats

“…The plasma concentration of the patients who were administered a single 2 mg/kg dose of lidocaine into the trachea was measured. The time to peak concentration was 0.75 minute and the peak plasma concentration reached 2.27 ± 0.92 mg/L 17,18 , which suggests that lidocaine is well-absorbed through trachea. The drug concentration of Group LG was lower than that of Group LS after 10 minutes of treatment ( Figure 1A).…”

“…The toxic and side-effects of lidocaine are mainly determined by the peak plasma concentration 17 . Slowing down or reducing the rate of absorption of lidocaine is an important way to reduce the peak plasma concentration and the toxic and side-effects of administering lidocaine via the airway.…”

The laryngeal mask airway for administration of surfactant in two neonates with respiratory distress syndrome

“…(6) and Prengel et al . (3) showing that a large proportion of methylene blue and lidocaine, respectively, injected into the airway tube reaches the adult lung. Challiner et al .…”

“…The Classic TM laryngeal mask airway (LMA) has been used as a conduit for the pulmonary administration of a variety of drugs including salbutamol (1), adrenaline (2), lidocaine (3) and fibrin glue (4). These have been administered via nebulization of inspired gases (1), injection of fluid into the airway tube (2,3) or injection of fluid into the tracheobronchial tree via a catheter (3) or fibreoptic scope (4). We report the use of the LMA for pulmonary administration of surfactant in two neonates with respiratory distress syndrome.…”

4

“…80 Лидокаин и атропин также можно вводить в трахеотрубку, но их концентрация в плазме после этого также вариабельна. [256][257][258] При невозможности быстрого установления венозного доступа рассмотрите вопрос о внутрикостном. Лишь при отсутствии сосудистого доступа (в/в, в/к) вводите препараты эндотрахеально.…”