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Topical Lidocaine During Airway Manipulation in Pediatric Anesthesia: A Systematic Review and Meta-Analysis

Elizabet Taylor Pimenta Weba1, Gabriel Soares de Sousa2,3,4, Alexandros Páris de Mesquita Ipácio1

  • 1State University of Maranhão Tocantine Region, Imperatriz, Brazil.

Paediatric Anaesthesia
|November 11, 2025
PubMed

Insights

Topical lidocaine significantly reduces laryngospasm, desaturation, and sore throat in pediatric patients undergoing airway management. Further research is needed for other respiratory adverse events, particularly in high-risk children.

Area of Science:

  • Anesthesiology
  • Pediatric Critical Care
  • Respiratory Medicine

Background:

  • Topical lidocaine is frequently used in pediatric anesthesia for airway management to mitigate airway and circulatory reflexes.
  • The precise efficacy of topical lidocaine in preventing adverse respiratory events in children remains incompletely understood.
  • This meta-analysis addresses the need for a comprehensive evaluation of topical lidocaine's impact on pediatric airway management outcomes.

Purpose of the Study:

  • To conduct a meta-analysis assessing the effectiveness of topical lidocaine in reducing respiratory adverse events during airway management in pediatric patients.
  • To synthesize evidence from randomized controlled trials to clarify the role of topical lidocaine in pediatric anesthesia.

Main Methods:

  • Systematic literature search of PubMed, Embase, and Cochrane databases.
  • Inclusion of 14 randomized controlled trials involving 1937 pediatric patients.
  • Statistical analysis using a random-effects model to calculate odds ratios and mean differences with 95% confidence intervals.

Main Results:

  • Topical lidocaine significantly decreased the incidence of laryngospasm (OR 0.50), desaturation (OR 0.49), and sore throat (OR 0.31).
  • No significant differences were found for bronchospasm, cough, severe cough, hoarseness, vomiting, or heart rate.
  • The analysis included 1937 pediatric patients, with 917 receiving topical lidocaine for airway procedures.

Conclusions:

  • Topical lidocaine demonstrates a potential benefit in reducing specific airway reflexes like laryngospasm, desaturation, and sore throat in pediatric patients.
  • The study highlights the need for additional research into the effects of topical lidocaine on other perioperative respiratory adverse events, especially in vulnerable pediatric populations.
Abstract

Keywords:
adverse eventsairway managementlidocainepediatric anesthesiatopical drug administration

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