Topical lidocaine reduces the risk of perioperative airway complications in children with upper respiratory tract infections

Abstract

Purpose To determine the effect of topically applied lidocaine on perioperative airway complications when using a laryngeal mask airway device (LMAD) in children either with or without a history of recent or ongoing upper respiratory tract infection (URI). Methods In a randomized controlled double-blind trial, 34 children with a history of recent or ongoing URI and 32 non-URI children-all of whom were younger than age ten and scheduled to undergo minor surgical procedureswere randomly assigned to either a lidocaine or a placebo group. In the lidocaine group, an LMAD was lubricated with lidocaine gel before insertion, and a clear lubricating gel was used in the placebo group. The following data were recorded after standardized anesthesia induction and airway management: postoperative complications, such as coughing, desaturation, laryngospasm, and increased oral secretions, as well as length of stay in the postanesthetic recovery unit. Results Children with URI had a lower overall perioperative complication rate if they received a lidocaine gel (35%) rather than placebo (94%) (P \ 0.01). Also, the incidence of postoperative coughing was less (12% vs 53%; P = 0.03). In non-URI patients, lidocaine did not significantly reduce the rate of airway complications compared with placebo (17% vs 24%, respectively).Conclusion Lubrication of the LMAD with lidocaine gel reduces the incidence of airway complications in children with an upper respiratory tract infection. RésuméObjectif De´terminer l'effet d'une application topique de lidocaı¨ne sur les complications pe´riope´ratoires au niveau des voies ae´riennes lors de l'utilisation d'un masque larynge( LMAD) chez des enfants avec ou sans infection re´cente ou actuelle des voies respiratoires supe´rieures. Méthode Dans une e´tude randomise´e contrôle´e à double insu, 34 enfants avec une infection re´cente ou actuelle des voies respiratoires supe´rieures et 32 enfants sans infection, tous plus jeunes que 10 ans et devant subir des interventions chirurgicales mineures, ont e´te´randomise´s a`recevoir soit de la lidocaı¨ne, soit un placebo. Dans le groupe lidocaı¨ne, un LMAD a e´te´lubrifie´a`l'aide de lidocaı¨ne en gel avant l'insertion, et un gel lubrifiant clair a e´te´utilise´dans le groupe placebo. Les donne´es suivantes ont e´te´enregistre´es apre`s une induction de l'anesthe´sie et une prise en charge standard des voies ae´riennes: les complications postope´ratoires, telles que toux, de´saturation, laryngospasme et se´cre´tions orales accrues, ainsi que la dure´e de se´jour dans la salle de re´veil post-anesthe´sique. Résultats Les enfants souffrant d'infection des voies respiratoires supe´rieures ont montre´un taux global de complications pe´riope´ratoires plus bas lorsqu'ils ont reçu de la lidocaı¨ne en gel (35 %) plutôt que le placebo (94 %) (P\0,01). De plus, l'incidence de toux postope´ratoire e´tait moindre (12 % vs 53 %; P = 0,03). Chez les patients ne souffrant pas d'infection des voies respiratoires supe´rieures, la lidocaı¨ne n'a pas re´duit le taux de ...

The efficacy of lidocaine to prevent laryngospasm in children: a systematic review and meta-analysis

“…There were three studies that reported mixed data for laryngospasm, stridor and bronchospasm . Adverse effects of lidocaine were not reported in these studies.…”

“…). Of the included studies, eight were available in English and one in Spanish . Eight studies were presented as peer‐reviewed papers and one as an unpublished abstract .…”

“…The details of all included studies are shown in Table . Lidocaine was administered intravenously in five studies and topically in five studies . Intravenous lidocaine was administered in doses between 1.0 and 2.0 mg.kg −1 before tracheal extubation.…”

“…Methods of topical lidocaine application included lidocaine spray on to the larynx , lidocaine spray to the supraglottic, glottic and subglottic areas , aerosol administration or lidocaine jelly placed on the dorsal surface of the supraglottic airway device . Topical lidocaine was administered before induction in one study , before intubation in one study , at the time of intubation in one study and during supraglottic airway device insertion in two studies .…”

Lignocaine topicalization of the pediatric airway

“…Both these studies looked exclusively at the incidence of postextubation laryngospasm in patients undergoing tonsillectomy and adenoidectomy, a cohort of patients who are likely to be at increased risk of laryngospasm. The other three studies (19)(20)(21) found no difference in the incidence of laryngospasm following topicalization. As laryngospasm is a relatively rare occurrence in the general pediatric population, these studies may have been underpowered to detect a difference.…”