Application of Lidocaine Spray for Tracheal Intubation in Neonates - A Clinical Trial Study

Abstract

Background:Tracheal intubation is extremely distressing, painful, and may influence heart rate and blood pressure. Sedatives, analgesics, and muscle relaxants are not commonly used for intubation in neonates.Objectives:This study aimed to evaluate the effects of lidocaine spray as a non-intravenous drug before neonatal intubation on blood pressure, heart rate, oxygen saturation and time of intubation.Patients and Methods:In a randomized, controlled study each neonate was randomly assigned to one of the two study groups by staffs who were not involved in the infant's care. The allocation concealment was kept in an opaque sealed envelope, and the investigators, the patient care team, and the assessors were blinded to the treatment allocation. The selected setting was NICU unit of a teaching hospital in Ilam city, Iran and participants were 60 neonates with indication of tracheal intubation with gestational age > 30 weeks. Patients in the treatment group received lidocaine spray and the placebo group received spray of normal saline prior to intubation. Main outcome measurements were the mean rates of blood pressure, heart rate, oxygen saturation, intubation time and lidocaine side effects were measured before and after intubation.Results:Totally 60 newborns including 31 boys and 29 girls were entered into the study (drug group n = 30; placebo group n = 30). Boy/girl ratio in treatment and placebo groups were 1.3 and 0.88, respectively. Mean age ± SD of participants was 34.1 ± 24.8 hours (treatment: 35.3 ± 25.7; placebo: 32.9 ± 24.3; P < 0.0001). Mean weight ± SD of neonates was 2012.5 ± 969 g. Application of lidocaine spray caused a significant reduction of mean intubation time among treatment group compared with placebo group (treatment: 15.03 ± 2.2 seconds; placebo: 18.3 ± 2.3 seconds; P < 0.0001). Mean blood pressure, heart rate and oxygen saturation rate, among neonates in treatment group was reduced after intubation compared with their relevant figures before intubation; however, their differences were not statistically significant except for mean oxygen saturation rate that was reduced significantly in placebo group. No side effects were observed during study.Conclusions:Though the current study revealed some promising results in the application of lidocaine spray during neonatal intubation without any considerable side effects; however, the current investigation could only be considered as a pilot study for further attempts in different locations with higher sample sizes and in different situations.

Effects of Nebulized Albuterol in Transient Tachypnea of the Newborn A Clinical Trial

“…So far, no effective drug therapy was introduced for the treatment of TTN and its standard treatment is the use of supplemental oxygen and respiratory support but severe resistant cases also need intubation and mechanical ventilation. Respiratory support with intubation has a lot of side effects such as changes in the blood pressure, intraventricular hemorrhage, and also respiratory support with mechanical ventilation is accompanied with numerous complications (10). Accordingly, we hypothesized that nebulized Salbutamol (albuterol), may enhance lung fluid absorption in patients with TTN and might be effective in reduction of respiratory symptoms of these neonates.…”

On-table extubation in neonates undergoing anoplasty: an experience of anesthetic management on the concept of fast-tracking anesthesia

“…A previous study reported that 6.5% topical lidocaine spray in neonatal intubation did not induce any considerable side effects. [19] Current evidence supports the local application of lidocaine <4 mg/kg to be safe in pediatric patients. [20] Atomized lidocaine has several advantages over non-atomized liquid, including higher plasma concentration and an increased surface area because of the smaller atomized particles when compared with conventional lidocaine spray.…”

Effect of intratracheal dexmedetomidine administration on recovery from general anaesthesia after gynaecological laparoscopic surgery: a randomised double-blinded study

“… 18 Being a non-invasive and highly convenient method, intratracheal administration has been successfully used to deliver many drugs in various clinical settings, such as the use of lidocaine sprays in tracheal intubation. 19 The intratracheal administration of Dex could represent an alternative method in particular circumstances when an intravenous line is not possible. In addition, it might be more simple and convenient to apply intratracheal Dex than intranasal Dex during general anaesthesia with an oral or nasal intubation.…”