Prophylactic lidocaine use preintubation: a review

Area of Science:

• Anesthesiology
• Pharmacology
• Critical Care Medicine

Background:

• Intubation can trigger adverse cardiovascular responses, including elevated blood pressure, pulse, and intracranial pressure.
• These responses pose significant risks, particularly for patients with pre-existing conditions like atherosclerotic heart disease or eye injuries.
• Airway reflexes such as coughing and dysrhythmias are also common during intubation.

Purpose of the Study:

• To review the efficacy of prophylactic lidocaine as a preintubation medication.
• To evaluate lidocaine's role in mitigating the physiological stress associated with endotracheal intubation.
• To determine optimal dosing and administration routes for preintubation lidocaine.

Main Methods:

• Systematic review of existing studies on prophylactic lidocaine use before intubation.
• Analysis of data regarding lidocaine's impact on cardiovascular parameters, airway reflexes, and patient safety.
• Evaluation of different lidocaine dosages and administration methods (intravenous and endotracheal).

Main Results:

• Lidocaine is consistently effective in blunting cough reflexes and preventing dysrhythmias.
• Evidence suggests lidocaine can mitigate increases in pulse, blood pressure, intracranial, and intraocular pressure.
• No adverse effects of prophylactic lidocaine administration prior to intubation have been documented.

Conclusions:

• Prophylactic lidocaine is a safe and effective adjunct for preintubation medication.
• An intravenous dose of 1.5 mg/kg administered 3 minutes prior to intubation is considered optimal.
• Endotracheal administration (5-6 mg/kg in 6 cc) is recommended for suctioning intubated patients.