Comparison of the Hemodynamic Response of Intravenous and Topical Lidocaine to Endotracheal Intubation

Abstract

Abstract Aim: To compare the effects of 10% lidocaine spray and intravenous (IV) lidocaine on hemodynamic responses, postoperative throat pain, and coughing following laryngoscopy and endotracheal intubation. Methods: A total of 120 patients, aged 18 to 65 years and scheduled for elective surgery, were randomized into two groups: Group 1 (n=60) received 10% lidocaine spray (three puffs, 30 mg), while Group 2 (n=60) was administered 1.5 mg/kg of IV lidocaine. Intubation was performed by the same individual three minutes after mask ventilation. Systolic, diastolic, and mean arterial blood pressures, along with heart rate, were recorded at baseline and at 2, 4, 6, 8, and 10 minutes after intubation. Immediately upon transfer to the recovery unit, coughing and throat pain were assessed. The data were compared using ANOVA, Scheffe, and repeated measures tests, with the significance level being accepted as p<0.05. Results: The comparative analysis between the groups revealed a significantly lower heart rate at 1 minute after intubation in Group 2 (p=0.03). No significant differences were observed in systolic and mean arterial blood pressure measurements. Diastolic blood pressure at 10 minutes was significantly lower in Group 2 (p=0.02). Postoperative throat pain and coughing were statistically lower in Group 1 than in Group 2 at the postoperative first hour (p<0.001 and p<0.003, respectively). Conclusions: There was no significant difference in the suppression of hemodynamic responses between the groups, except for the heart rate measured at 1 minute. Throat pain and coughing were lower in the lidocaine spray group

Keywords

• intubation
• hemodynamic response
• throat pain
• cough

References

1. 1. Kayhan Z. Endotracheal entübasyon. Klinik Anestezi. Extended 3rd ed. İstanbul, Logos Yayıncılık, 2004.
2. 2. Parr SM. Induction of anaesthesia. Fundamentals of Anaesthesia, 2nd ed (Eds Pinnock C, Lin T, Smith T): 30. London, Greenwich Medical Media Ltd, 2003.
3. 3. Hung O. Understanding hemodynamic responses to tracheal intubation. Can J Anaesth. 2001; 48: 723-6.
4. 4. Gal TJ. Airway management. Miller’s Anesthesia, 6th ed (Ed Miller RD): 1617-52. Philadelphia, Elsevier Churchill Livingstone, 2005.
5. 5. Mikawa K, Nishina K, Maekawa N, et al. Comparison of nicardipine, diltiazem and verapamil for controlling the cardiovascular responses to tracheal intubation. Br J Anaesth. 1996; 76: 221-226.
6. 6. Mikawa K, Nishina K, Takao Y, et al. Attenuation of cardiovascular responses to tracheal extubation: comparison of verapamil, lidocaine, and verapamil-lidocaine combination. Anesth Analg. 1997; 85: 1005-10. 7. Hamaya Y, Dohi S. Differences in cardiovascular response to airway stimulation at different sites and blockade of the responses by lidocaine. Anesthesiology. 2000; 93: 95-103.
7. 8. Morgan EG, Mikhail MS, Murray MJ. Airway management. Clinical Anesthesiology, 3rd ed: New York:, The McGrawHill Companies, 2002.
8. 9. Lev R, Rosen P. Prophylactic lidocaine use preintubation: a review. J Emerg Med. 1994; 12: 499-506.

9. 10. Bidwai AV, Bidwai VA, Rogers CR, et al. Blood-pressure and pulse-rate responses to endotracheal extubation with and without prior injection of lidocaine. Anesthesiology. 1979; 51: 171-3.
10. 11. Rossi S. Australian Medicines Handbook. Adelaide, Australian Medicines Handbook Pty Limited, 2006.
11. 12. Helfman SM, Gold MI, DeLisser EA, et al. Which drug prevents tachycardia and hypertension associated with tracheal intubation: lidocaine, fentanyl, or esmolol? Anesth Analg. 1991; 72: 482-6.
12. 13. van den Berg AA, Savva D, Honjol NM. Attenuation of the haemodynamic responses to noxious stimuli in patients undergoing cataract surgery. A comparison of magnesium sulphate, esmolol, lignocaine, nitroglycerine, and placebo given i.v. with induction of anaesthesia. Eur J Anaesthesiol. 1997; 14:134-47.
13. 14. Sun HL, Wu TJ, Ng CC, et al. Efficacy of oropharyngeal lidocaine instillation on hemodynamic responses to orotracheal intubation. J Clin Anesth. 2009; 21: 103-7.
14. 15. Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg. 2004; 99: 1253-7.
15. 16. Hung NK, Wu CT, Chan SM, et al. Effect on postoperative sore throat of spraying the endotracheal tube cuff with benzydamine hydrochloride, 10% lidocaine, and 2% lidocaine. Anesth Analg. 2010; 111: 882-6.
16. 17. Maruyama K, Sakai H, Miyazawa H, et al. Laryngotracheal application of lidocaine spray increases the incidence of postoperative sore throat after total intravenous anesthesia. J Anesth. 2004; 18: 237-40.