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Lidocaine attenuates the intraocular pressure response to rapid intubation in children
Insights
Intravenous lidocaine significantly reduces the intraocular pressure (IOP) spike following laryngoscopy and intubation in children. This anesthetic intervention helps maintain stable IOP during pediatric airway procedures.
Area of Science:
- Anesthesiology
- Ophthalmology
- Pediatric Medicine
Background:
- Intraocular pressure (IOP) can increase significantly during laryngoscopy and intubation.
- This IOP response poses risks, particularly in pediatric patients undergoing anesthesia.
- Effective methods to attenuate this response are crucial for patient safety.
Purpose of the Study:
- To evaluate the efficacy of intravenous lidocaine in blunting the IOP response to laryngoscopy and intubation in children.
- To compare IOP changes in children receiving lidocaine versus a saline control.
Main Methods:
- Twenty children (ages 1-10) received either intravenous lidocaine (1.5 mg/kg) or sterile water (control).
- Anesthesia was induced with pancuronium, thiopentone, and atropine, maintained with volatile agents.
- Intraocular pressure was measured using applanation tonometry before intubation and for five minutes post-intubation.
Main Results:
- The control group showed a significant IOP increase (27%) post-intubation (p<0.05).
- The lidocaine group exhibited a non-significant IOP increase (9.8%) post-intubation.
- IOP in the lidocaine group decreased below baseline within three minutes (p<0.05).
- Systolic blood pressure and heart rate remained stable in both groups post-intubation.
Conclusions:
- Intravenous lidocaine (1.5 mg/kg) effectively attenuates the IOP response to laryngoscopy and intubation in pediatric anesthesia.
- Lidocaine administration is a safe and effective adjunct for managing IOP during pediatric airway procedures.
- This finding supports the use of lidocaine to mitigate IOP fluctuations in pediatric patients.
Abstract:
To determine the effect of intravenous lidocaine on the intraocular pressure (IOP) response to laryngoscopy and intubation, twenty unpremedicated children, ages one to ten years were studied. After administration of either intravenous sterile water (control) (n = 10) or preservative-free lidocaine (1.5 mg X kg-1) (n = 10), anaesthesia was induced with pancuronium (0.15 mg X kg-1), thiopentone (5 mg X kg-1), and atropine (0.02 mg X kg-1), and maintained with halothane, nitrous oxide and oxygen. The trachea was intubated one minute after administration of thiopentone. IOP (measured by applanation tonometry), heart rate, and systolic blood pressure were measured at the time of loss of the eyelid reflex (time 0), immediately after endotracheal intubation, and each minute thereafter for five minutes. In the control group, IOP increased (27 per cent) significantly after intubation (p less than 0.05), whereas in the lidocaine group, IOP did not increase (9.8 per cent) significantly after intubation. IOP decreased below time 0 values within three minutes after loss of the eyelid reflex in the lidocaine group (p less than 0.05). At each measurement (except time 0), IOP was significantly greater in the control group than in the lidocaine group (p less than 0.05). Heart rate and systolic blood pressure did not increase significantly in either group after intubation. We conclude that intravenous lidocaine (1.5 mg X kg-1) significantly attenuates the IOP response to laryngoscopy and intubation in children anaesthetized with pancuronium, thiopentone, and atropine.