Effect of Lidocaine on ICP Response to Endotracheal Suctioning

Endotracheal Lidocaine in Preventing Endotracheal Suctioning-induced Changes in Cerebral Hemodynamics in Patients with Severe Head Trauma

“…These adverse cerebral hemodynamic events can have catastrophic consequences, especially, when cerebral auto-regulation is lost because of head trauma [8,9]. Although several techniques or pharmacological agents have been proposed to prevent increased ICP during endotracheal suctioning in patients with severe head trauma, including hyperventilation [10], muscle relaxants [1] and topical, and systemic use of local anesthetics including lidocaine [1,11,12] and more recently infusion of the sedative opioid remifentanil [13], all have adverse effects that limit their clinical application. Hyperventilation, for example, abruptly reduces carbon dioxide tension, and thereby, reducing cerebral perfusion thus increasing the risk of cerebral ischemia [14] and causes hyperinflation thus worsening ICP [15].…”

Which is Safer to Avoid an Increase in ICP After Endotracheal Suctioning in Severe Head Injury: Intravenous or Endotracheal Lidocaine?

“…A consistent dosage of 1.5 mg/kg IVL was administered across the six human studies. Nevertheless, ETL dosage varied across human studies from 1.5 mL/kg to 4 mL of lidocaine 4% [6,11,13,20,21,29]. In our study 1.5 mg/kg IVL was administered which was the same as Groeben et al [25] who obtained a plasma concentration of 2.4 ± 0.15 μg/mL.…”

“…In our previous practical and clinical analysis, we have noted clinical controversy surrounding administration of lidocaine before ES in patients with brain injury and we have observed that there is no guideline of safety and effectiveness of this practice, arousing controversy over the best route and doses with consequent limitations on the universal implementations. In our research, it was applied the literature recommended dosage that should be administered in the endotracheal tube or intravenously [11,13]. It was not our intention to compare or question the safety and effectiveness of different doses of lidocaine.…”

“…Lidocaine-injected IV blunts the cough reflex in awake and anesthetized patients and evidence demonstrates that lidocaine sprayed down the ETT attenuates the airway-circulatory reflexes during emergency and extubation after general anesthesia [13][14][15]. These facts prompted us to reappraise the issue of endotracheal lidocaine instillation for blunting ES induced cerebral hemodynamic changes in patients undergoing intensive care after severe head trauma.…”

Assessment and Management of the Pediatric Airway

“…Heart rate and blood pressure should be monitored closely, as suctioning may stimulate the vagus nerve and produce bradycardia. Lidocaine (administered tracheally, 5-6 mg/kg dose diluted in 6 mL 0.9% saline 5-10 min before suctioning) may be administered in children with head trauma [56][57][58] before the airway is suctioned in order to blunt the increase in intracranial pressure (ICP) that may result from the suctioning [59][60][61][62].…”