Summary
A technique of nebulizing lidocaine in the upper airways was developed and its effectiveness in preventing cardiovascular responses to laryngoscopy and intubation was documented. In ten pre-treated patients the average percentage-rise in systolic blood pressure was 10.3 per cent and there were no arrhythmias. The pulse rate increased by 16.8 per cent. In ten control patients, the systolic blood pressure increased by 56 per cent and the incidence of arrhythmias was 40 per cent. The pulse rate increased by 38.8 per cent. The significance and application of these results is discussed and compared to other available methods. The opinion is expressed that the effect of the aerosol, especially as it relates to the suppression of arrhythmias, is partly due to systemic absorption of lidocaine.
Résumé
Nous avons procédé à l’étude de l’abolition du réflexe cardio-vasculaire lors de la laryngoscopie et de l’intubation à l’aide d’une technique d’inhalation d’un aérosol de lidocaine avant l’induction de l’anaesthésie.
Dans les dix cas du groupe traits l’augmentation de la tension artérielle pendant l’intubation, par rapport à l’état stable antérieur fut de 10.3 pour cent pour la pression systolique et de 16.4 pour cent pour la diastolique. L’augmentation du pouls fut de 16.8 pour cent et on n’observe pas d’arythmie.
Dans dix autres cas, servant de contrôle, nous avons pratiqué la technique habituellement utilisée, à savoir la vaporisation de lidocaine à 10 pour cent immédiatement avant l’intubation. Les résultats furent les suivants : augmentation de la tension artérielle de 56 pour cent pour la systolique, 66 pour cent pour la diastolique, augmentation du pouls de 38.8 pour cent et incidence d’arythmie de 40 pour cent.
Cette technique d’aérosol de lidocaine pré-opératoire s’est avérée facile et efficace, pouvant être administrée par le patient lui-même, et est en definitive supérieure à la méthode de routine pre-intubation.
Il faut noter que l’absorption systemique de la lidocaine a pu contribuer à la stabilité cardio-vasculaire et à l’absence d’arythmie.
Notre discussion porte sur les résultats, et compare notre méthode à d’autres déjà publiées.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Burstein, C.L., Lo Pinto, F.J., &Newman, W. Electrocardiographic studies during endotracheal intubation. I. Effects during usual routine technics. Anesthesiology11: 224 (1950).
Burstein, C.L., Woloshin, G., &Newman, W. Electrocardiographic studies during endotracheal intubation. II. Effects during general anaesthesia and intravenous procaine. Anesthesiology11: 299 (1950).
Noble, M.J. &Derrick, W.S. Changes in electrocardiogram during endotracheal intubation and induction of anaesthesia. Canad. Anaesthetists’ Society Journal6: 276 (1959).
DeVault, M., Greifenstein, F.E., &Harris Jr.,L.C. Circulatory responses to endotracheal intubation in light general anaesthesia — the effect of atropine and phentolamine. Anesthesiology21: 360 (1960).
Wycoff, C.C. Endotracheal intubation: effects on blood pressure and pulse rate. Anesthesiology21: 153 (1960).
Takeshima, K., Noda K., &Higaki, M. Cardiovascular response to rapid anaesthesia induction and endotracheal intubation. Anesth. Analg. Curr. Res.43: 201 (1964).
Sacarminaca, J. &Wynands, J.E. Atropine and the electrical activity of the heart during induction of anaesthesia in children. Canad. Anaesthetists’ Society Journal10: 328 (1963).
Gibbs, J.M. The effects of endotracheal intubation on cardiac rate and rhythm. N.Z. Med. J.66: 465 (1967).
Dottori, O., Lof, B. Ax:son &Ygge, H. Heart rate and arterial blood pressure during different forms of induction of anaesthesia in patients with mitral stenosis and constrictive pericarditis. Brit. J. of Anaesthesia42: 849 (1970).
Forbes, A.M. &Dally, F.G. Acute hypertension during induction of anaesthesia and endotracheal intubation in normotensive man. Brit. J. of Anaesthesia42: 618 (1970).
Phys-Roberts, C., Greene, L.T., Meloche, R., &Foex, P. Studies of anaesthesia in relation to hypertension. II. Haemodynamic consequences of induction and endotracheal intubation. Brit. J. Anaesth.43: 531 (1971).
Prys-Roberts, C., Foex, P., Biro, G.P., &Roberts, J.G. Studies of Anaesthesia in relation to hypertension. V: Adrenergic beta-receptor blockade. Brit. J. Anaesth.45: 671 (1973).
Dalton, B. &Guiney, T.,et al. Myocardial ischemia from tachycardia and hypertension in coronary heart disease — patients undergoing anaesthesia. Ann. Mtg. American Soc. of Anesthesiologists, Boston, 1972, pp. 201–202.
Molnar, W. &Prior, J.A. Anaesthesia for bronchography utilizing intermittent positive pressure breathing apparatus. Am. J. of Roentgenology, Rad. Ther. and Nucl. Med.87: 836 (1962).
Tomashefski, J.F., Nelson, S.W., &Christoforidis, A.J. Oropharyngeal and tracheobronchial aerosol anaesthesia. Dis. of the Chest.42: 181 (1962).
Nelson, S.W. &Christoforidis, A.J. An automatic inhalation-actuated aerosol anaesthesia unit: a new method of applying topical anaesthesia to the oropharynx and tracheobronchial tree. Radiology82: 226 (1964).
Edhorn, G.A. Determination of lidocaine in whole blood by gas chromatography. Canad. Anaesthetists’ Soc. J.18: 189 (1971).
Dripps, R.D., Eckenhoff, J.E., &Vandam, L.D. Introduction to anaesthesia, 4th edition. Philadelphia, W.B. Saunders Co. (1972).
Bromage, R., Robson, J. Concentrations of lignocaine in the blood after intravenous, intramuscular, epidural and endotracheal administration. Anaesthesia.16: 461 (1961).
Steinhaus, J.E. &Gaskin, L. A study of intravenous lidocaine as suppressant of cough reflex. Anesthesiology24: 285 (1963).
Telivuo, L. An experimental study on the absorption of some local anaesthetics through the lower respiratory tract. Acta Anaesthesiologica Scan., Supp.16: 121 (1965).
Pelton, D.A., Daly, M., Cooper, P.D., &Conn, A.W. Lidocaine: concentrations in plasma following aerosol application to trachea and bronchi. Canad. Anaesthetists’ Society J.27: 250 (1970).
Gianelly, R., Von Der Groeben, J.U., Spivack, A., &Harrison, D.C. Effect of lidocaine on ventricular arrhythmias in patients with coronary heart disease. New Engl. J. of Medicine277: 1215 (1967).
Tomori, Z. &Widdicombe, J.G. Muscular and cardiovascular reflexes elicited by mechanical stimulation of the respiratory tract. J. Physiol.200: 25 (1969).
Corbett, J.L., Kerr, J.H. &Prys-Roberts, C. Cardiovascular responses to aspiration of secretions from the respiratory tract in man. J. Physiol.201: 511 (1969).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Abou-Madi, M., Keszler, H. & Yacoub, O. A method for prevention of cardiovascular reactions to laryngoscopy and intubation. Canad. Anaesth. Soc. J. 22, 316–329 (1975). https://doi.org/10.1007/BF03004841
Issue Date:
DOI: https://doi.org/10.1007/BF03004841