The Effect of Using Topical Lidocaine on Blade and Cuff of Laryngoscope, and Tracheal Mucosa on Changes of Heart Rate and Blood Pressure during Laryngoscopy and Intubation

Document Type : Original Article (s)

Authors

1 Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Laryngoscopy is a common procedure in general anesthesia; but some problems such as laryngospasm and tachycardia may occur during laryngoscopy. This study aimed to determine the effect of using topical lidocaine on blade and cuff of laryngoscope tube, and tracheal mucosa on changes of heart rate and blood pressure during laryngoscopy and intubation.Methods: In a clinical trial study, 275 patients, candidates for laryngoscopy, were selected and randomly divided in 5 groups of 55. 4 groups received lidocaine spray 10% on laryngoscope blade, intratracheal, on the cuff of laryngoscope tube, on blade plus cuff and plus intratracheal, respectively, and the fifth group did not receive lidocaine. Heart rate and blood pressure were measured in base, before laryngoscopy, and 1, 3, 5, and 10 minutes after laryngoscopy and compared between the five groups.Findings: Spraying lidocaine on endotracheal cuff and laryngoscope blade led to decrease of complications such as tachycardia, bradycardia, hypotension, and hypertension. So, heart rate and blood pressure were the highest in the control group and mean changes of heart rate and blood pressure were significantly different between the five groups (P < 0.05); but mean changes of oxygen saturation was not statistically deferent between the 5 groups.Conclusion: Spraying lidocaine 10% of the blade and cuff of laryngoscope, and intratracheal led to decrease of heart rate and blood pressure and probably, these methods can be used for decrease of complications due to laryngoscopy.

Keywords


  1. Basali A, Mascha EJ, Kalfas I, Schubert A. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. Anesthesiology 2000; 93(1): 48-54.
  2. Greving JP, Wermer MJ, Brown RD, Jr., Morita A, Juvela S, Yonekura M, et al. Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: A pooled analysis of six prospective cohort studies. Lancet Neurol 2014; 13(1): 59-66.
  3. Tada Y, Wada K, Shimada K, Makino H, Liang EI, Murakami S, et al. Roles of hypertension in the rupture of intracranial aneurysms. Stroke 2014; 45(2): 579-86.
  4. Pillai S, Praharaj SS, Rao GS, Kolluri VR. Cerebral perfusion pressure management of severe diffuse head injury: effect on brain compliance and intracranial pressure. Neurol India 2004; 52(1): 67-71.
  5. De LG, van't Hof AW, Huber K, Gibson CM, Bellandi F, Arntz HR, et al. Impact of hypertension on distal embolization, myocardial perfusion, and mortality in patients with ST segment elevation myocardial infarction undergoing primary angioplasty. Am J Cardiol 2013; 112(8): 1083-6.
  6. 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.
  7. Takita K, Morimoto Y, Kemmotsu O. Tracheal lidocaine attenuates the cardiovascular response to endotracheal intubation. Can J Anaesth 2001; 48(8): 732-6.
  8. Mostafa SM, Murthy BV, Barrett PJ, McHugh P. Comparison of the effects of topical lignocaine spray applied before or after induction of anaesthesia on the pressor response to direct laryngoscopy and intubation. Eur J Anaesthesiol 1999; 16(1): 7-10.
  9. Bulow K, Nielsen TG, Lund J. The effect of topical lignocaine on intubating conditions after propofol-alfentanil induction. Acta Anaesthesiol Scand 1996; 40(6): 752-6.
  10. Lee DH, Park SJ. Effects of 10% lidocaine spray on arterial pressure increase due to suspension laryngoscopy and cough during extubation. Korean J Anesthesiol 2011; 60(6): 422-7.
  11. Krage R, van Rijn C, van Groeningen D, Loer SA, Schwarte LA, Schober P. Cormack-Lehane classification revisited. Br J Anaesth 2010; 105(2): 220-7.
  12. Guignard B, Menigaux C, Dupont X, Fletcher D, Chauvin M. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesth Analg 2000; 90(1): 161-7.
  13. Hamill JF, Bedford RF, Weaver DC, Colohan AR. Lidocaine before endotracheal intubation: intravenous or laryngotracheal? Anesthesiology 1981; 55(5): 578-81.
  14. Yusa T, Taira Y, Sasara T, Yoza K. Effects of intratracheal lidocaine spray on circulatory responses to endotracheal intubation. Masui 1990; 39(10): 1325-32. In Japanese].
  15. Derbyshire DR, Smith G, Achola KJ. Effect of topical lignocaine on the sympathoadrenal responses to tracheal intubation. Br J Anaesth 1987; 59(3): 300-4.
  16. Safavi M, Honarmand A. A comparison of different doses of remifentanil and tracheal lidocaine on attenuation of cardiovascular responses to laryngoscopy and tracheal intubation. Turk J Med Sci 2009; 39(3): 439-45.
  17. Min JH, Chai HS, Kim YH, Chae YK, Choi SS, Lee A, et al. Attenuation of hemodynamic responses to laryngoscopy and tracheal intubation during rapid sequence induction: remifentanil vs. lidocaine with esmolol. Minerva Anestesiol 2010; 76(3): 188-92.
  18. Ithnin F, Lim Y, Shah M, Shen L, Sia AT. Tracheal intubating conditions using propofol and remifentanil target-controlled infusion: A comparison of remifentanil EC50 for Glidescope and Macintosh. Eur J Anaesthesiol 2009; 26(3): 223-8.
  19. Albertin A, Casati A, Federica L, Roberto V, Travaglini V, Bergonzi P, et al. The effect-site concentration of remifentanil blunting cardiovascular responses to tracheal intubation and skin incision during bispectral index-guided propofol anesthesia. Anesth Analg 2005; 101(1): 125-30, table.
  20. Hug CC, Jr., McLeskey CH, Nahrwold ML, Roizen MF, Stanley TH, Thisted RA, et al. Hemodynamic effects of propofol: data from over 25,000 patients. Anesth Analg 1993; 77(4 Suppl): S21-S29.
  21. Hiller SC, Mazurek MS. Monitored anesthesia care. In: Barash PG, Cullen BF, Stoelting RK, editors. Clinical anesthesia. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2006. p.1246-61.