Abstract
Purpose
Minimizing hemodynamic changes during the peri-intubation period is a concern for anesthesiologists. We investigated the effect of lidocaine sprayed on the laryngoscope blade and trachea on hemodynamics during direct laryngoscopic intubation.
Methods
Seventy-two patients were randomly allocated to one of four groups: 10 % lidocaine was sprayed either on the laryngoscope blade (group L), on the trachea (group V), or on the laryngoscope blade and the trachea (group LV). No lidocaine was used in group C. Anesthesia was induced in all patients with remifentanil (effect site concentration: 4.0 ng/ml) and propofol (effect site concentration 4.0 μg/ml) continuous infusion using a target control infusion (TCI) device. Mean arterial pressure (MAP) and heart rate (HR) were recorded during the peri-intubation period.
Results
Changes in MAP and HR over time were markedly different among the four groups (P < 0.05). MAP at 1 min post-intubation was significantly lower in groups L, V, and LV than in group C (86.1 ± 12.7, 85.3 ± 12.6, and 83.7 ± 13.1 vs 106.3 ± 22.9 mmHg, P < 0.01). Maximum MAP values were lower in groups L and LV than in group C (P < 0.05). HRs at 1, 2, and 3 min post-intubation were lower in group LV than in group C (70.4 ± 9.0 vs 84.2 ± 15.3; 64.0 ± 8.1 vs 79.2 ± 15.4; 61.6 ± 8.3 vs 77.2 ± 14.5 beats/min, P < 0.01, respectively).
Conclusions
Lidocaine sprayed on the laryngoscope blade and/or trachea reduced the hemodynamic response to laryngoscopic intubation during the post-intubation period following anesthetic induction with remifentanil and propofol using a TCI device.
Similar content being viewed by others
References
Ismail SA, Bisher NA, Kandil HW, Mowafi HA, Atawia HA. Intraocular pressure and haemodynamic responses to insertion of the i-gel, laryngeal mask airway or endotracheal tube. Eur J Anaesthesiol. 2011;28:443–8.
Basali A, Mascha EJ, Kalfas I, Schubert A. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. Anesthesiology. 2000;93:48–54.
Greving JP, Wermer MJ, Brown RD Jr, Morita A, Juvela S, Yonekura M, Ishibashi T, Torner JC, Nakayama T, Rinkel GJ, Algra A. Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol. 2014;13:59–66.
Tada Y, Wada K, Shimada K, Makino H, Liang EI, Murakami S, Kudo M, Kitazato KT, Nagahiro S, Hashimoto T. Roles of hypertension in the rupture of intracranial aneurysms. Stroke. 2014;45:579–86
Pillai S, Praharaj SS, Rao GS, Kolluri VR. Cerebral perfusion pressure management of severe diffuse head injury: effect on brain compliance and intracranial pressure. Neurol India. 2004;52:67–71.
De Luca G, van’t Hof AW, Huber K, Gibson CM, Bellandi F, Arntz HR, Maioli M, Noc M, Zorman S, Zeymer U, Gabriel HM, Emre A, Cutlip D, Rakowski T, Gyongyosi M, Dudek D, cooperation E. Impact of hypertension on distal embolization, myocardial perfusion, and mortality in patients with ST segment elevation myocardial infarction undergoing primary angioplasty. Am J Cardiol. 2013;112:1083–6.
Shribman A, Smith G, Achola K. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth. 1987;59:295–9.
Takita K, Morimoto Y, Kemmotsu O. Tracheal lidocaine attenuates the cardiovascular response to endotracheal intubation. Can J Anaesth. 2001;48:732–6.
Mostafa S, Murthy B, Barrett P, McHugh P. Comparison of the effects of topical lignocaine spray applied before or after induction of anaesthesia on the pressor response to direct laryngoscopy and intubation. Eur J Anaesthesiol. 1999;16:7–10.
Bulow K, Nielsen TG, Lund J. The effect of topical lignocaine on intubating conditions after propofol-alfentanil induction. Acta Anaesthesiol Scand. 1996;40:752–6.
Lee DH, Park SJ. Effects of 10% lidocaine spray on arterial pressure increase due to suspension laryngoscopy and cough during extubation. Korean J Anesthesiol. 2011;60:422–7.
Sun HL, Wu TJ, Ng CC, Chien CC, Huang CC, Chie WC. Efficacy of oropharyngeal lidocaine instillation on hemodynamic responses to orotracheal intubation. J Clin Anesth. 2009;21:103–7.
Jeon YT, Hwang JW, Kim K, Jung CK, Park HP, Park SH. Optimal headrest height for the best laryngoscopic view: by anatomical measurements. Am J Emerg Med. 2012;30:1679–83.
Krage R, van Rijn C, van Groeningen D, Loer SA, Schwarte LA, Schober P. Cormack–Lehane classification revisited. Br J Anaesth. 2010;105:220–7.
Guignard B, Menigaux C, Dupont X, Fletcher D, Chauvin M. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesth Analg. 2000;90:161–7.
Yusa T, Taira Y, Sasara T, Yoza K. Effects of intratracheal lidocaine spray on circulatory responses to endotracheal intubation (in Japanese with English abstract). Masui (Jpn J Anesthesiol). 1990;39:1325–32.
Hamill JF, Bedford RF, Weaver DC, Colohan AR. Lidocaine before endotracheal intubation: intravenous or laryngotracheal? Anesthesiology. 1981;55:578–80.
Derbyshire D, Smith G, Achola K. Effect of topical lignocaine on the sympathodrenal responses to tracheal intubation. Br J Anaesth. 1987;59:300–4.
Safavi M, Honarmand A. A comparison of different doses of remifentanil and tracheal lidocaine on attenuation of cardiovascular responses to laryngoscopy and tracheal intubation. Turk J Med Sci. 2009;39:439–45.
Min JH, Chai HS, Kim YH, Chae YK, Choi SS, Lee A, Choi YS. Attenuation of hemodynamic responses to laryngoscopy and tracheal intubation during rapid sequence induction: remifentanil vs. lidocaine with esmolol. Minerva Anestesiol. 2010;76:188–92.
Ithnin F, Lim Y, Shah M, Shen L, Sia AT. Tracheal intubating conditions using propofol and remifentanil target-controlled infusion: a comparison of remifentanil EC50 for Glidescope and Macintosh. Eur J Anaesthesiol. 2009;26:223–8.
Albertin A, Casati A, Federica L, Roberto V, Travaglini V, Bergonzi P, Torri G. The effect-site concentration of remifentanil blunting cardiovascular responses to tracheal intubation and skin incision during bispectral index-guided propofol anesthesia. Anesth Analg. 2005;101:125–30.
Kwak H, Min S, Kim D, Kang M, Kim J. Effect-site concentration of remifentanil for nasotracheal versus orotracheal intubation during target-controlled infusion of propofol. J Int Med Res. 2011;39:1816–23.
Kim JS, Kim DH, Min SK, Kim KM, Kim JP. Comparison of effect-site concentration of remifentanil for tracheal intubation with the lightwand and laryngoscopy during propofol target-controlled infusion. Korean J Anesthesiol. 2011;60:393–7.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Lee, SY., Min, J.J., Kim, H.J. et al. Hemodynamic effects of topical lidocaine on the laryngoscope blade and trachea during endotracheal intubation: a prospective, double-blind, randomized study. J Anesth 28, 668–675 (2014). https://doi.org/10.1007/s00540-014-1812-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-014-1812-z