Lignocaine topicalization of the pediatric airway

Abstract

The application of topical laryngeal lignocaine is a technique used frequently in pediatric anesthesia. It is often used to facilitate open airway procedures, tracheal intubation, or to reduce the incidence of perioperative adverse respiratory events such as coughing and laryngospasm. A number of studies have shown that applying topical lignocaine to the larynx reduces perioperative respiratory adverse events, while others have shown an increased incidence of respiratory complications with lignocaine administration. There is a lack of evidence on the effect of topical lignocaine on the sensitivity of upper airway reflexes and swallowing, the duration of time that airway reflexes are obtunded, and the optimum and safe maximum dose of lignocaine when used by this route. We review the current literature relating to the use of lignocaine to topicalize the pediatric airway. This review concentrates on the indications for use, the maximum safe dose, the effect on swallowing, and risk of aspiration and the complications of the technique.

Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults

“…Topical lidocaine has a dose‐dependent duration of analgesic action of up to 40 min although this may vary with concentration and method of administration . However, the time to return of laryngeal reflexes can be longer . Given that the terminal elimination half‐life of lidocaine is up to 2 h, patients should remain nil by mouth for at least 2 h following airway topicalisation for ATI (Grade D).…”

“…However, the time to return of laryngeal reflexes can be longer [151]. Given that the terminal elimination half-life of lidocaine is up to 2 h, patients should remain nil by mouth for at least 2 h following airway topicalisation for ATI (Grade D).…”

Failed videolaryngoscopy in an infant with giant vallecular cyst managed successfully with a ‘three-person technique’ of fibre-optic intubation

“…Awake intubation was not considered in our case because the child was uncooperative. Awake FOB can be quite challenging in this age group because of lack of co-operation, limitation on the dose of local anaesthetics for topicalisation and may have to be guided by transillumination and expiratory air bubbles 4 10. Also, in the presence of CAO, attempts at awake intubation can be very distressing.…”

Essential notes: the anaesthetic management of an inhaled foreign body in a child

“…cannula. 6 If the child coughs, oxygenate the patient's lungs with a facemask until spontaneous ventilation resumes, and then continue to topicalise the airway. If the child continues to cough with the local anaesthetic, then the patient is not ready for surgery.…”