Would you administer lidocaine for intubation?
Answer:
The administration of intravenous lidocaine 1 to 1.5 mg per kg several minutes prior to intubation to prevent reflex-induced bronchospasm is a long-standing practice. However, some caution is required, as paradoxical bronchospasm has been demonstrated in patients with asthma. It appears that while intravenous lidocaine reduces airway responsiveness to drugs and stimuli that cause bronchospasm, lidocaine on its own does not reduce baseline airway tone, and may actually increase it. Therefore, intravenous lidocaine should be administered with care in these patients.
Alternatively, topical endotracheal spray of lidocaine can be used. However, inhalation of lidocaine is itself irritating and can provoke bronchospasm in a patient with asthma. If lidocaine spray is used to tropicalize the airway, an adequate depth of anesthesia should be achieved before lidocaine is administered.
Reference(s):
- Burches BR Jr, Warner DO. Bronchospasm after intravenous lidocaine. Anesth Analg. 2008;107:1260-1262.
- Chang HY, Togias A, Brown RH. The effects of systemic lidocaine on airway tone and pulmonary function in asthmatic subjects. Anesth Analg. 2007;104:1109-1115.
- Maslow AD, Regan MM, Israel E, et al. Inhaled albuterol, but not intravenous lidocaine, protects against intubation-induced bronchoconstriction in asthma. Anesthesiology. 2000;93:1198-1204.
- McAlpine LG, Thomson NC. Lidocaine-induced bronchoconstriction in asthmatic patients. Relation to histamine airway responsiveness and effect of preservative. Chest. 1989;96:1012-1015.
- Woods BD, Sladen RN. Perioperative considerations for the patient with asthma and bronchospasm. Br J Anaesth. 2009;103(suppl 1):i57-i65.