Does Intravenous Lidocaine Prevent Laryngospasm after Extubation in Children?

Abstract

LElCHT P, WISBORG T, Does intravenous lidocaine prevent laryngospasm after extubation in children? Anesth Analg 1985;64:1193-6. CHRAEMMER-JBRGENSEN B.One huridred otherwise healthy children undergoing tonsillectomy were investigated in a double-blind study to exaiizine the effect of intrazienous lidocaine in preventiiig laryngospasni upon extubation. The children were anesthetized with N,O-0,-halothaize and orally intubated. They were raridonzly given lidocaine, 1.5 mglkg, or saliiie intrazleiiously prior to extubation, which took place at the same depth of anesthesia, izanrcly wheii there were signs of s z t d lozi1iiig activity. Eleven childreiz ( 2 % ) in each group of 50 dez~eloped laryngospasm. Froiii our findings it is coiicluded that lidocaine, I .5 nzglkg, does not prevent laryngospasm upori extubation zuhen extubatioil is carried out at the start of swallowing activity.Intravenous lidocaine has been shown to suppress effectively persistent cough caused by bronchoscopy (1). Lidocaine, given topically to the larynx and trachea (2) or intravenously (3), has been shown to blunt the increases in heart rate and blood pressure associated with laryngoscopy and endotracheal intubation. The data of Hamill et al. (4) indicated that lidocaine prevented intracranial hypertension after intubation and also limited the intensity and duration of cardiovascular stimulation. Furthermore, they showed that the intravenous route was the preferred technique for administering lidocaine. Bidwai et al.(5) demonstrated that intravenous lidocaine prevented coughing and increases in blood pressure and heart rate during and after endotracheal extubation. Adenotonsillectomy, a brief surgical procedure, can present major acute problems of bleeding, airway obstruction, and cardiac arrhythmias. As a consequence, the patient must have a rapid return to responsiveness with intact protective airway reflexes before tracheal extubation. Occasionally, this procedure is followed by laryngospasm, a serious complication, which is almost always associated with airway manipulation by the anesthesiologist or with the presence of foreign material in the larynx of the lightly anesthetized patient. In an open study including 40 children undergoing tonsillectomy, Baraka (6) showed that intravenous lidocaine prevented extubation laryngospasm. The purpose of this controlled clinical trial using doubleblind technique was, therefore, to confirm or reject the asserted prophylactic effect of lidocaine against laryngospasm after tracheal extubation. Material and MethodsOne hundred otherwise healthy children older than 1 yr of age and with a body weight less than 40 kg scheduled for elective tonsillectomy under general anesthesia participated in the study. Children with known hypersensitivity to lidocaine were not included. The study protocol was approved by the Copenhagen County Human Investigation Committee. Informed consent was obtained from the parents of all participating children.All the children were premedicated half an hour prior to expected induction ...

The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

“…However, as the risk of developing hypoxaemia under the clinical condition of 'stridor' (narrowing of the laryngeal aperture) vs 'laryngospasm' (complete closure of the laryngeal aperture) is considerably different, this combined assessment has important limitations. The true incidence of laryngospasm is unknown; Leicht et al [8] could show no effect of intravenous lidocaine on the incidence of laryngospasm; however, they defined laryngospasm as stridor during inspiration, occlusion (no airflow) or the presence of cyanosis. In their study, true laryngospasm, i.e.…”

“…An increased incidence of laryngospasm and apnoea is observed in children compared with adults and complications resulting from hypoxaemia are more common and more severe in children [2][3][4]. Lidocaine has been demonstrated to reduce the incidence of laryngospasm in anaesthetised children [5,6]; however, its effectiveness has been questioned [7,8]. Uncertainty regarding its usefulness is partly explained by the fact that most clinical studies were underpowered to assess the relatively rare event of laryngospasm.…”

Pediatric laryngospasm: prevention and treatment

“…lidocaine at 2 mg/kg 60-90 s before extubation in children undergoing T&A. However, Leicht et al [99] underwent a similar investigation and found contradictory results; they attributed this to the different time interval of lidocaine administration (4.5 min) and claimed that lidocaine can be effective when trachea is extubated before signs of swallowing occur. Topical lidocaine at 4 mg/kg is equally effective in preventing laryngospasm in children and neonates [54,100].…”

Anesthetic management of pediatric adenotonsillectomy

“…35 Lidocaine has showed varying effects in this regard, with some studies seeming to show a benefit, 36 and others failing to show this effect. 37 …”