The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

Abstract

SummaryWe studied the effect of intravenous lidocaine on laryngeal and respiratory reflex responses in children anaesthetised with sevoflurane. We tested the hypothesis that the incidence of laryngospasm evoked by laryngeal stimulation is temporarily diminished after the administration of lidocaine. Forty children, aged between 25 and 84 months, were anaesthetised with sevoflurane and breathed spontaneously through a laryngeal mask airway. Respiratory reflex responses were elicited by spraying distilled water onto the laryngeal mucosa at three time intervals: (i) before lidocaine was administered (baseline); (ii) at 2 min and (iii) at 10 min following the intravenous administration of a bolus of lidocaine 2 mg.kg )1 . A blinded reviewer assessed the evoked responses. The incidence of laryngospasm was reduced from 38% at baseline to 15% 2 min after lidocaine administration (p < 0.02) and 18% 10 min after lidocaine administration (p = 0.10). We conclude that intravenous lidocaine significantly reduced the incidence of laryngospasm but that the effect was short-lived. Protecting the lungs from aspiration is vitally important and is largely regulated by laryngeal and respiratory reflexes such as coughing, laryngospasm, expiration reflex, spasmodic panting and apnoea. However, exaggerated upper airway reflexes, particularly laryngospasm, have the potential to cause harm [1]. An increased incidence of laryngospasm and apnoea is observed in children compared with adults and complications resulting from hypoxaemia are more common and more severe in children [2][3][4]. Lidocaine has been demonstrated to reduce the incidence of laryngospasm in anaesthetised children [5,6]; however, its effectiveness has been questioned [7,8]. Uncertainty regarding its usefulness is partly explained by the fact that most clinical studies were underpowered to assess the relatively rare event of laryngospasm. Often more common adverse effects, such as stridor and the occurrence of hypoxaemia from whatever cause, were included in analyses assessing its incidence. Furthermore, studies examining the action of intravenous lidocaine on cough suppression during tracheal intubation revealed that the effect may only last a few minutes [9]. The potentially transient nature of this effect might make evaluation in the clinical setting difficult.

Perbandingan Pemberian Lidokain 2% 1,5 mg/kgBB Intravena dengan Propofol 0,3 mg/kgBB Intravena Setelah Anestesi Umum Dihentikan terhadap Kejadian Batuk Saat Ekstubasi Bangun

“…Lidokain telah terbukti menurunkan angka kejadian batuk dan laringospasme akibat penggunaan ETT. 6,8 Berdasar atas analisis statistik pada penelitian ini, angka kejadian batuk pada pemberian lidokain 2% 1,5 mg/kgBB lebih rendah dibanding dengan pemberian propofol 0,3 mg/kgBB (p<0,05). Angka kejadian batuk pada pemberian lidokain 2% 1,5 mg/kgBB sebesar 19,4%, sedangkan pada kelompok propofol 0,3 mg/kgBB sebesar 44,4%.…”

“…Lidokain menghambat penghantaran impuls RAR dan serabut C (yang merupakan inervasi utama di seluruh jalan napas dan paru) jalur aferen nervus vagus ke medula oblongata sebagai pusat batuk. 6,[8][9][10][11] Penggunaan lidokain untuk mencegah komplikasi ekstubasi telah dilaporkan pada penelitian sebelumnya. Penelitian di India tahun 2010 dan di Iran tahun 2011 pada subjek penelitian yang akan menjalani prosedur anestesi umum dengan ETT telah membuktikan bahwa 1,5 mg/kgBB lidokain 2% intravena menurunkan kejadian laringospasme secara signifikan.…”

“…Lidokain juga memblok kanal natrium (Na + ) neuron sensorik sehingga tidak terjadi pembentukan potensial aksi dan konduksi neuron yang dipicu oleh berbagai stimulasi serabut aferen jalan napas. 8,13 Propofol juga merupakan obat anestetik yang dapat menurunkan angka kejadian batuk meskipun efeknya pada penelitian ini lebih rendah dibanding dengan lidokain. Propofol menurunkan eksitabilitas neuron dengan meningkatkan aktivitas reseptor gammaaminobutyric acid (GABA) A di sel postsinaptik.…”

“…Berdasar atas mekanisme batuk di atas, lidokain lebih baik karena lidokain lebih banyak bekerja pada reseptor yang menginervasi jalan napas terutama di trakea. [4][5][6][7][8][9]14 Penelitian di Korea pada tahun 2014 mengenai efek propofol dosis subhipnotik 0,3 mg/kgBB terhadap insidensi dan keparahan batuk terhadap 60 subjek penelitian yang menjalani prosedur operasi nasal dengan anestesi umum sevofluran-ramifentanil menyimpulkan bahwa propofol dosis 0,3 mg/ kgBB menurunkan insidensi dan keparahan batuk saat ekstubasi. Insidensi batuk saat ekstubasi menurun sebesar 27%.…”

What's new in pediatric acute pain therapy?

“…Nalbuphine, intravenous dosage regimen demonstrated preventive analgesia by intravenous lidocaine, not associated with a specific regimen or dosage. Until now, lidocaine is only investigated in children in the laryngeal reflex responses to tracheal intubation [43], and as an adjunct to propofol to prevent or reduce injection pain [44,45]. However, the low-dose co-administration of lidocaine intravenously is a promising concept to further reduce postoperative pain therapy requirements, for example, in children with open appendectomy, when caudal block is not possible or contraindicated.…”