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Published on: January 13, 2017
Comparing topical administration of lidocaine alone and in combination with alfentanil in children undergoing
Alireza Takzare1, Parastou Ariana1, Bita Malekianzadeh1
1Department of Anaesthesiology, Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Adding alfentanil to topical lidocaine for pediatric bronchoscopy did not affect vital signs or complications but significantly increased recovery time. This suggests lidocaine alone is sufficient for topical anesthesia in these procedures.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Anesthesia management for pediatric airway surgery and endoscopy presents challenges, requiring deep anesthesia while maintaining spontaneous breathing.
- Combining general and topical anesthesia is a potential strategy.
- Opioids have known peripheral effects that warrant investigation.
Purpose of the Study:
- To compare the central effects of topical lidocaine alone versus lidocaine combined with the opioid alfentanil in pediatric patients undergoing flexible diagnostic bronchoscopy.
- To evaluate the impact of adding alfentanil on anesthetic and recovery parameters.
Main Methods:
- A randomized clinical trial involving 40 ASA class I-II children (1-6 years) undergoing flexible diagnostic bronchoscopy.
- Participants were divided into two groups: topical lidocaine alone or topical lidocaine with alfentanil.
- Data collected included demographics, anesthesia duration, blood pressure, bronchoscopy duration, and recovery time.
Main Results:
- Demographic variables were similar between groups, confirming successful randomization.
- No significant differences were observed in blood pressure, heart rate, anesthesia duration, or perioperative complications between the lidocaine and lidocaine-alfentanil groups.
- A significant increase in recovery time was noted in the lidocaine-alfentanil group (18.75 min) compared to the lidocaine-only group (13.05 min).
Conclusions:
- Topical administration of opioids with lidocaine during bronchoscopy does not influence hemodynamic stability, anesthesia duration, or complication rates.
- The addition of alfentanil to topical lidocaine prolongs recovery time in pediatric patients.
- Lidocaine alone may be sufficient for topical anesthesia in pediatric bronchoscopy, optimizing recovery.
Introduction:
Airway surgery and endoscopy in pediatric patients are always associated with challenges in anesthesia management. Deep anesthesia is required for preventing patient bucking during the procedure but patient breath should be maintained; in this regard, a combination of general and topical anesthesia can be beneficial. There is also evidence of the peripheral effects of opioids. The main objective of this study is to compare using lidocaine topically alone and combined with alfentanil opioids with respect to the central effects of opioids.
Methods:
In this study, 40 ASA class I and II children, aged 1-6 years, who were candidates for flexible diagnostic bronchoscopy were divided into two groups through block randomization using the random number table after obtaining parents' consent in complete health conditions. In this clinical trial, for collecting the data a special data collection form was used at the bedside of patients undergoing bronchoscopy at Pediatric Medical Center in 2017. Data including demographic information (age, weight, gender), duration of anesthesia, blood pressure before and after drug administration, duration of bronchoscopy, and recovery time were recorded in a form.
Findings:
In terms of demographic variables, there were not any significant differences between the two studied groups, indicating that the groups were matched and randomized appropriately. Although there were not any significant differences between the two groups of using lidocaine alone and in combination with alfentanil in other variables, in the recovery time a significant difference was observed between the two groups, with a mean of 13.05 min in the lidocaine group and 18.75 min in the lidocaine combined with alfentanil group.
Conclusion:
Topical administration of opioid with lidocaine through bronchoscopy had no impact on blood pressure, heart rate, anesthesia duration, and the frequency of perioperative complications.
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