Nebulized Lidocaine to Attenuate the Cardiovascular Response to Direct Laryngoscopy and Tracheal Intubation
TEXAS UNIV HEALTH SCIENCE CENTER AT HOUSTON SCHOOL OF NURSING
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This study described the use of 120 mg nebulized lidocaine to attenuate the cardiovascular response to direct laryngoscopy and tracheal intubation in ASA I and ASA II patients undergoing various surgical procedures. A convenience sample of 53 patients requiring general endotracheal anesthesia was included in the study. An experimental study design was utilized. Patients were randomly assigned to one of two treatment groups 3 ml of 4 nebulized lidocaine or 3 ml of nebulized saline via an anesthesia face mask. All subjects were given midazolam 0.03 mgkg Iv preoperatively and then either nebulized lidocaine or saline according to the group assigned. After preoxygenation, all subjects were given fentanyl 1.5 mgkg Iv, thiopental 4.0 mgkg IV 1 minute after injection of the fentanyl and rocuronium 0.6 mgkg IV after apnea and establishment of a patent airway. intubation with a Macintosh blade was accomplished after a loss of four twitches in a train-of-four ratio. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at 30, 90, and 180 second intervals after laryngoscopy. immediately following intubation, 1 isoflurane was dialed in to maintain anesthesia. in response to laryngoscopy and tracheal intubation, there were no statistically significant differences between the nebulized lidocaine and saline groups. The study implication, therefore, is that anesthesia care providers should continue their current practice of using other agents such as IV lidocaine, opioids or beta blockers to attenuate post-intubation cardiovascular responses. Time of laryngoscopy should, however, be during the topical peak effect of lidocaine which is 2 to 5 minutes after completion of nebulization, as opposed to the effective anesthesia time of 30 minutes.
- Medicine and Medical Research
- Stress Physiology