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Volume 16, Issue 1 (2024)
Iran J War Public Health 2024, 16(1): 67-74 |
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Received: 2023/11/7 | Accepted: 2024/03/4 | Published: 2024/03/28
Received: 2023/11/7 | Accepted: 2024/03/4 | Published: 2024/03/28
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Saeed Z, Jaafar H, Alburkiebh S. Effect of Nebulized Lidocaine and Intravenous Lidocaine on Hemodynamic Responses to Laryngoscopy and Endotracheal Intubation. Iran J War Public Health 2024; 16 (1) :67-74
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1- Department of Clinical Laboratory, Faculty of Pharmacy, Kufa University Jaafar, Kufa, Iraq
2- Department of Surgery, Medical College, Kufa University, Kufa, Iraq
3- Department of Anesthesia, Faculty of Surgery, Kufa University, Kufa, Iraq
2- Department of Surgery, Medical College, Kufa University, Kufa, Iraq
3- Department of Anesthesia, Faculty of Surgery, Kufa University, Kufa, Iraq
Abstract (342 Views)
Aims: Laryngoscopy and endotracheal intubation are critical steps in general anesthesia and elicit significant sympatho-adrenal responses. Mitigating these responses is essential for safely inducing anesthesia, especially in patients with cardiac or cerebrovascular disease, as these responses can lead to serious complications. This study evaluated the effectiveness of two methods of administering lidocaine in attenuating the hemodynamic response to laryngoscopy and endotracheal intubation.
Materials & Methods: In this experimental study, 78 patients were divided into three groups (each 26 members). The control group received 5ml of intravenous normal saline and induction drugs. The intravenous lidocaine group received 1.5mg/kg of 2% intravenous lidocaine 2 minutes before laryngoscopy and intubation. The nebulized lidocaine group was administered 4ml of 2% lidocaine via a cirrus nebulizer with a 5L/min oxygen flow, usually 10 to 15 minutes, followed immediately by induction.
Findings: Demographic data across the three groups showed no significant differences. However, when comparing the control and nebulized lidocaine groups, nebulized lidocaine had a significant advantage in attenuating hemodynamic responses. Comparisons between the control and intravenous lidocaine groups revealed significant differences in some readings, indicating an incomplete blunting effect.
Conclusion: Nebulized lidocaine is more effective than intravenous lidocaine in reducing the hemodynamic changes associated with direct laryngoscopy and endotracheal intubation.
Materials & Methods: In this experimental study, 78 patients were divided into three groups (each 26 members). The control group received 5ml of intravenous normal saline and induction drugs. The intravenous lidocaine group received 1.5mg/kg of 2% intravenous lidocaine 2 minutes before laryngoscopy and intubation. The nebulized lidocaine group was administered 4ml of 2% lidocaine via a cirrus nebulizer with a 5L/min oxygen flow, usually 10 to 15 minutes, followed immediately by induction.
Findings: Demographic data across the three groups showed no significant differences. However, when comparing the control and nebulized lidocaine groups, nebulized lidocaine had a significant advantage in attenuating hemodynamic responses. Comparisons between the control and intravenous lidocaine groups revealed significant differences in some readings, indicating an incomplete blunting effect.
Conclusion: Nebulized lidocaine is more effective than intravenous lidocaine in reducing the hemodynamic changes associated with direct laryngoscopy and endotracheal intubation.
Keywords:
References
1. Gropper MA, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NA, Leslie K, editors. Miller's Anesthesia. 9th ed. Philadelphia: Elsevier; 2019. [Link]
2. Yentis S, Hirsch NP, Ip J. Anaesthesia, intensive care, and perioperative medicine A-Z: An encyclopedia of principles and practice. 6th ed. New York: Elsevier; 2018. [Link]
3. Prys-Roberts C, Foëx P, Biro GP, Roberts JG. Studies of anaesthesia in relation to hypertension V: Adrenergic beta-receptor blockade. Br J Anaesth. 1973;45(7):671-81. [Link] [DOI:10.1093/bja/45.7.671]
4. Mort TC. Complications of emergency tracheal intubation: Hemodynamic alterations-part I. J Intensive Care Med. 2007;22(3):157-65. [Link] [DOI:10.1177/0885066607299525]
5. Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth. 1987;59(3):295-9. [Link] [DOI:10.1093/bja/59.3.295]
6. Bucx MJL, Snijders CJ. Force, torque, and stress relaxation with direct laryngoscopy. Anesth Analg. 1996;83(5):1130. [Link] [DOI:10.1213/00000539-199611000-00048]
7. Bucx MJL, Scheck PAE, Geel RTM, Ouden AH, Niesing R. Measurement of forces during laryngoscopy. Anaesthesia. 1992;47(4):348-51. [Link] [DOI:10.1111/j.1365-2044.1992.tb02180.x]
8. Henderson J. Airway management in the adult. In: Miller RD, editor. Miller's Anesthesia. 7th ed. London: Elsevier Churchill Livingstone; 2010. p. 1573-610. [Link] [DOI:10.1016/B978-0-443-06959-8.00050-9]
9. King BD, Harris LC, Greifenstein FE, Elder JD, Dripps RD. Reflex circulatory responses to direct laryngoscopy and tracheal intubation performed during general anesthesia. Anesthesiology. 1951;12(5):556-66. [Link] [DOI:10.1097/00000542-195109000-00002]
10. Ng WS. Pathological effects of tracheal intubation. In: Latto IP, Rosen M, editors. Difficulties in tracheal intubation. London: Elsevier Health Sciences; 1985. p. 14. [Link]
11. Finfer SR, Mackenzie SI, Saddler JM, Watkins TG. Cardiovascular responses to tracheal intubation: A comparison of direct laryngoscopy and fibreoptic intubation. Anaesth Intensive Care. 1989;17(1):44-8. [Link] [DOI:10.1177/0310057X8901700110]
12. Bishop MJ, Harrington RM, Tencer AF. Force applied during tracheal intubation. Anesth Analg. 1992;74(3):411-4. [Link] [DOI:10.1213/00000539-199203000-00016]
13. Derbyshire DR, Chmielewski A, Fell D, Vater M, Achola K, Smith G. Plasma catecholamine responses to tracheal intubation. Br J Anaesth. 1983;55(9):855-60. [Link] [DOI:10.1093/bja/55.9.855]
14. Bonica JJ. Autonomic innervation of the viscera in relation to nerve block. Anesthesiology. 1968;29(4):793-813. [Link] [DOI:10.1097/00000542-196807000-00023]
15. Landsberg L, Young JB. Catecholamines and the adrenal medulla. In: Wilson JD, editor. Williams' textbook of endocrinology. Philadelphia: WB Saunders; 1998. p. 621-705. [Link]
16. Wattwil M, Sundberg A, Olsson J, Nordström S. Thoracolumbar epidural anaesthesia blocks the circulatory response to laryngoscopy and intubation. Acta Anaesthesiol Scand. 1987;31(6):529-31. [Link] [DOI:10.1111/j.1399-6576.1987.tb02616.x]
17. Dohi S, Nishikawa T, Ujike Y, Mayumi T. Circulatory responses to airway stimulation and cervical epidural blockade. Anesthesiology. 1982;57(5):359-63. [Link] [DOI:10.1097/00000542-198211000-00002]
18. Barret K, Barman S, Boitano S, Brooks H. Ganong's review of medical physiology. 25th ed. New York: McGraw-Hill; 2015. [Link]
19. Stone JG, Foëx P, Sear JW, Johnson LL, Khambatta HJ, Triner L. Risk of myocardial ischaemia during anaesthesia in treated and untreated hypertensive patients. Br J Anaesth. 1988;61(6):675-9. [Link] [DOI:10.1093/bja/61.6.675]
20. Fujii Y, Tanaka H, Toyooka H. Circulatory responses to laryngeal mask airway insertion or tracheal intubation in normotensive and hypertensive patients. Can J Anaesth. 1995;42(1):32-6. [Link] [DOI:10.1007/BF03010568]
21. Low JM, Harvey JT, Prys-Roberts C, Dagnino J. Studies of anaesthesia in relation to hypertension. Br J Anaesth. 1986;58(5):471-7. [Link] [DOI:10.1093/bja/58.5.471]
22. Goldman L, Caldera DL. Risks of general anesthesia and elective operation in the hypertensive patient. Anesthesiology. 1979;50(4):285-92. [Link] [DOI:10.1097/00000542-197904000-00002]
23. Mohan K, Mohana RL. Attenuation of cardiovascular responses to laryngoscopy and intubation by diltiazem and lignocaine: A comparative study. Int J Med Res Health Sci. 2013;2(3):557-63. [Link] [DOI:10.5958/j.2319-5886.2.3.098]
24. Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail's clinical anesthesiology. 5th ed. New York: McGraw-Hill; 2013. [Link]
25. Fox EJ, Sklar GS, Hill CH, Villanueva R, King BD. Complications related to the pressor response to endotracheal intubation. Anesthesiology. 1977;47(6):524-5. [Link] [DOI:10.1097/00000542-197712000-00013]
26. Swarnamba UN, Veena K, Shaikh SI. Comparison of the efficacy of lornoxicam and fentanyl in attenuating the hemodynamic response to laryngoscopy and intubation. Anesth Essays Res. 2016;10(3):478-82. [Link] [DOI:10.4103/0259-1162.177521]
27. Tetzlaff JE. The pharmacology of local anesthetics. Anesthesiol Clin North Am. 2000;18(2):217-33. [Link] [DOI:10.1016/S0889-8537(05)70161-9]
28. Barash M, Reich KA, Rademaker D. Lidocaine-induced methemoglobinemia: A clinical reminder. J Am Osteopath Assoc. 2015;115(2):94-8. [Link] [DOI:10.7556/jaoa.2015.020]
29. Jee D, Park SY. Lidocaine sprayed down the endotracheal tube attenuates the airway-circulatory reflexes by local anesthesia during emergence and extubation. Anesth Analg. 2003;96(1):293-7. [Link] [DOI:10.1213/00000539-200301000-00058]
30. Tarn S, Chung F, Campbell M. Intravenous lidocaine: Optimal time of injection before tracheal intubation. Anesth Analg. 1987;66(10):1036-38. [Link] [DOI:10.1213/00000539-198710000-00026]
31. Abou-Madi MN, Keszler H, Yacoub JM. Cardiovascular reactions to laryngoscopy and tracheal intubation following small and large intravenous doses of lidocaine. Can Anaesth Soc J. 1977;24(1):12-9. [Link] [DOI:10.1007/BF03006808]
32. John G. Regional anesthesia. In: Dershwitz M, Walz J, editors. Anesthesiology examination and board review. 7th ed. New York: McGraw-Hill; 2013. [Link]
33. Weiss EB, Patwardhan AV. The response to lidocaine in bronchial asthma. Chest. 1977;72(4):429-38. [Link] [DOI:10.1378/chest.72.4.429]
34. Bromage PR, Robson JG. Concentrations of lidocaine in the blood after intravenous, intramuscular, epidural, and endotracheal administration. Anesthesia. 1961;16(4):461-78. [Link] [DOI:10.1111/j.1365-2044.1961.tb13426.x]
35. Viegas O, Stoelting RK. Lidocaine in arterial blood after laryngotracheal administration. Anesthesiology. 1975;43(4):491-3. [Link] [DOI:10.1097/00000542-197510000-00019]
36. Scott DB, Littlewood DG, Covino BG, Drummond GB. Plasma lignocaine concentrations following endotracheal spraying with an aerosol. Br J Anaesth. 1976;48(9):899-902. [Link] [DOI:10.1093/bja/48.9.899]
37. Chong CF, Chen CC, Ma HP, Wu YC, Chen YC, Wang TL. Comparison of lidocaine and bronchodilator inhalation treatments for cough suppression in patients with chronic obstructive pulmonary disease. Emerg Med J. 2005;22(6):429-32. [Link] [DOI:10.1136/emj.2004.015719]
38. Groeben H, Schlicht M, Stieglitz S, Pavlakovic G, Peters J. Both local anesthetics and salbutamol pretreatment affect reflex bronchoconstriction in volunteers with asthma undergoing awake fiberoptic intubation. Anesthesiology. 2002;97(6):1445-50. [Link] [DOI:10.1097/00000542-200212000-00016]
39. Efthimiou J, Higenbottam T, Holt D, Cochrane GM. Plasma concentrations of lignocaine during fibreoptic bronchoscopy. Thorax. 1982;37(1):68-71. [Link] [DOI:10.1136/thx.37.1.68]
40. Becker DE, Reed KL. Local anesthetics: Review of pharmacological considerations. Anesth Prog. 2012;59(2):90-102. [Link] [DOI:10.2344/0003-3006-59.2.90]
41. Omote K, Kirita A, Namiki A, Iwasaki H. Effects of nicardipine on the circulatory responses to tracheal intubation in normotensive and hypertensive patients. Anaesthesia. 1992;47(1):24-7. [Link] [DOI:10.1111/j.1365-2044.1992.tb01947.x]
42. Forbes AM, Dally FG. Acute hypertension during induction of anaesthesia and endotracheal intubation in normotensive man. Br J Anaesth. 1970;42(7):618-24. [Link] [DOI:10.1093/bja/42.7.618]
43. Venus B, Polassani V, Pham CG. Effects of aerosolized lidocaine on circulatory responses to laryngoscopy and tracheal intubation. Crit Care Med. 1984;12(4):391-4. [Link] [DOI:10.1097/00003246-198404000-00011]
44. Pelton DA, Daly M, Cooper PD, Conn AW. Plasma lidocaine concentrations following topical aerosol application to the trachea and bronchi. Can Anaesth Soc J. 1970;17(3):250-5. [Link] [DOI:10.1007/BF03004603]
45. Shehata A, Abd El-Hamid AM, Hasan AM, Abd El-Fattah MH. Lidocaine nebulizer reduce response to endotracheal intubation and the need for postoperative analgesia after nasal operations. J Am Sci. 2013;9(12):287-91. [Link]
46. Sklar BZ, Lurie S, Ezri T, Krichelli D, Savir I, Soroker D. Lidocaine inhalation attenuates the circulatory response to laryngoscopy and endotracheal intubation. J Clin Anesth. 1992;4(5):382-5. [Link] [DOI:10.1016/0952-8180(92)90160-3]
47. Kumar A, Seth A, Prakash S, Deganwa M, Gogia AR. Attenuation of the hemodynamic response to laryngoscopy and tracheal intubation with fentanyl, lignocaine nebulization, and a combination of both. Anesth Essays Res. 2016;10(3):661-6. [Link] [DOI:10.4103/0259-1162.191113]
48. Stoelting RK. Blood pressure and heart rate changes during short-duration laryngoscopy for tracheal intubation. Anesth Analg. 1978;57(2):197-9. [Link] [DOI:10.1213/00000539-197803000-00009]
49. Chinn WM, Zavala DC, Ambre J. Plasma levels of lidocaine following nebulized aerosol administration. Chest. 1977;71(3):346-8. [Link] [DOI:10.1378/chest.71.3.346]
50. Himes RS, Difazio CA, Burney RG. Effects of lidocaine on the anesthetic requirements for nitrous oxide and halothane. Anesthesiology. 1977;47(5):437-40. [Link] [DOI:10.1097/00000542-197711000-00010]
51. Ahmed AA, Haider HS. Comparative study between sprayed and inhaled nebulized lidocaine for suppression of hemodynamic response to laryngoscopy and oral endotracheal intubation. J Univ Shanghai Sci Technol. 2021;23(9):772. [Link] [DOI:10.51201/JUSST/21/09599]