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Updated: Mar 19, 2026
Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow
Published on: January 13, 2017
Site-directed topical lidocaine spray attenuates perioperative respiratory adverse events in children undergoing
Li-Wei Li1, Long He1, Yanqiu Ai1
1Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Insights
Topical lidocaine spray significantly reduced perioperative respiratory adverse events (PRAEs) in children undergoing intubation. This method lowered risks of laryngospasm, coughing, and desaturation, though it slightly increased extubation time.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Respiratory Medicine
Background:
- Perioperative respiratory adverse events (PRAEs) are a significant cause of morbidity and mortality in pediatric anesthesia.
- Topical lidocaine is proposed to mitigate PRAEs during endotracheal intubation in children, but evidence is limited by varied application methods.
- This study addresses the efficacy of site-directed topical airway lidocaine for reducing PRAE incidence.
Purpose of the Study:
- To evaluate the effect of site-directed topical airway lidocaine on the incidence of PRAE in children undergoing elective endotracheal intubation.
- To compare the incidence of specific PRAEs, including laryngospasm, coughing, and oxygen desaturation, between lidocaine and saline groups.
- To assess the impact of site-directed topical lidocaine on the time to extubation.
Main Methods:
- A randomized controlled double-blind clinical trial involving 322 children (6 months to 12 years) scheduled for elective surgery requiring endotracheal intubation.
- Patients were randomized to receive topical spray of lidocaine or saline directed at supraglottic, glottis, and subglottic areas before intubation.
- Incidence of PRAE and time to extubation were the primary outcome measures.
Main Results:
- The lidocaine group showed a significantly lower incidence of PRAE (12.80%) compared to the saline group (38.13%; P < 0.001).
- Specific reductions were observed in laryngospasm (1.7% vs 8.1%; P = 0.01), excessive coughing (4.3% vs 13.2%; P = 0.005), and oxygen desaturation <95% (6.8% vs 16.9%; P = 0.005) in the lidocaine group.
- Time to extubation was significantly longer in the lidocaine group (18.6 min) compared to the saline group (21.3 min; P = 0.03).
Conclusions:
- Site-directed topical lidocaine spray to the airway significantly reduces the incidence of PRAE in children undergoing tracheal intubation.
- The application of topical lidocaine was associated with a significant decrease in laryngospasm, coughing, and oxygen desaturation.
- While effective in reducing PRAE, topical lidocaine administration resulted in a slight prolongation of extubation time.
Background:
Perioperative respiratory adverse events (PRAEs) are a major cause of morbidity and mortality associated with pediatric anesthesia. Topical lidocaine administration reduces risk of PRAE in children undergoing elective endotracheal intubation. However, definitive evidence of its efficacy remains elusive, due, in part, to the wide variability in the methodology for spraying topical lidocaine. In this randomized controlled double-blind clinical trial, we sought to evaluate the effect of site-directed topical airway lidocaine, sprayed directly onto supraglottic, glottis, and subglottic areas, on the incidence of PRAE.
Methods:
The study population consisted of 322 children (age range, 6 mo-12 y), who were scheduled for an elective surgical procedure under general anesthesia with endotracheal intubation. Patients were randomly assigned to receive topical spray of lidocaine (group L) or saline (group S) over the supraglottic, glottis and subglottic areas under direct vision before tracheal intubation. Incidence of PRAE and time to extubation was recorded.
Results:
There were no statistically significant intergroup differences with regard to baseline demographics, patient characteristics, and surgical parameters. Group L was associated with a significantly lower incidence of PRAE as compared with group S (12.80% versus 38.13%, respectively; P < 0.001). Similarly, the incidence of laryngospasm (1.7% versus 8.1%; P = 0.01), excessive coughing (4.3% versus 13.2%; P = 0.005), and oxygen desaturation <95% (6.8% versus 16.9%; P = 0.005), respectively, was significantly lower in group L. However, time to extubation was longer in group L as compared with that in group S (18.6 ± 7.7 min versus 21.3 ± 8.9 min; P = 0.03).
Conclusions:
Site-directed topical spray of lidocaine over supraglottic, glottis, and subglottic areas before tracheal intubation significantly reduced the incidence of PRAE and a prolongation of extubation time in children.
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