Lidocaine topicalization?

  1. Can anyone tell me about using lidocaine prior to routine tracheal intubation?? It is a technique I am not familiar as I am from the UK and I have only seen it done by a few anesthetists.

    How common is it? Why do people do it as the patient has usually been paralyzed? Does it really stop hemodynamic changes or trauma? There are papers out there which say yes, there are ones that say no. What is it that you are actually topicalizing? The vocal cords? Trachea? To stop reflexes? Is it used just like in awake intubations? How long do you wait before it has taken effect? 1-5 minutes seems a long time to wait. How much of it do you use?

    I am a little confused and not sure if I should include it in my practice.

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    About Californiadreamer

    Joined: Oct '07; Posts: 21; Likes: 1
    Clinical Research Nurse
    Specialty: 4 year(s) of experience in ICU and agency (per diem)


  3. by   ello7
    I've seen it done only once. It was a patient who had a trach, then was decannulated. A few days later, they went into resp distress. So he used lidocaine through the trach stoma, then intubated orally. I'm not sure for the reasoning behind this.... It was my first intubation at the time, so I wasn't sure of the "norms". Looking back on it, I think it's so he didn't have to paralyze the patient. He just gave a large dose of Morphine, and then the lidocaine.

    But of all the other intubations I've seen, no one else has used lidocaine
  4. by   GilaRRT
    The reason for giving topical xylocaine is not about ICP, it is to prevent post operative coughing and other potential complications associated with intubation such as laryngeospasm. Generally, you want to apply xylocaine to the glottic area (to include the vocal cord area). Topical xylocaine is also used for awake intubation. I haven seen a cricoid puncture and injection into the glottic area through the cricoid membrane.

    When considering xylocaine as a pre-medication agent in head injury, the IV route is typically endorsed; however, there exists limited and weak evidence to even support the efficacy of using xylocaine to "blunt" ICP spikes during laryngoscopy. I am not aware of any papers that definitively state xylocaine leads to significant outcome improvements. However, nothing in the literature says xylocaine is particularly harmful.