nebulized lidocaine

[susi_q]

Did something new today ... well different purpose at least. Needed to put an NG down a very skittish patient ... doc said she had been reading about using nebulized lido prior to insertion, but didn't know the process. Did a little research and used the protocol that RT uses for chronic cough (3cc of 2%). Worked like a dream. He tolerated it great. Apparently the only adverse effect they have found is some risk for increased bleeding... presumably because they don't tell you when it's hurting. Will definately be suggesting it when the need comes up again!!!

[Altra, BSN, RN]

Very interesting ... and probably much better tolerated than that blast of Hurricane Spray.

[susi_q]

Very interesting ... and probably much better tolerated than that blast of Hurricane Spray.

Funny you should mention the Hurricane spray. That was the primary reason she sited for switching to lido. Had never even heard of methemoglobinemia ... but apparently that is a serious risk found with the use of Benzocaine.

Looked up a site to find out what she was talking about ... http://www.jhasim.com/files/journal_p45(V3-1)ClinicalV.pdf if you are interested.

[rn29306]

Nebulized lidocaine is indeed a very through anesthetic of the respiratory tree. We use it, time permitting of course, as one way to perform an awake intubation in the OR - 4mls of 4%. Just be aware that it severely diminishes one's ability to swallow and enhances possible aspiration. I used to be an ER tech and have swallowed viscous lidocaine on several occasions when my oropharynx was sore from coughing etc. Very potent anesthetic.

What strikes me as a little odd is that this is being used for NGT insertions. It is not like inhaled lidocaine enters the esophagus......Unless you are just trying to blunt the gag reflex in the hypopharynx. Hmmmmmmm.

Methemoglobinemia is a unique development. Once you see it, you will never forget it. Several indicators can point the process out, but the gold standard for diagnosis is an ABG. Ever seen chocolate milk arterial blood? I have an awesome powerpoint concerning this, pm me if you are interested.

[subee, MSN, CRNA]

Nebulized lidocaine is indeed a very through anesthetic of the respiratory tree. We use it, time permitting of course, as one way to perform an awake intubation in the OR - 4mls of 4%. Just be aware that it severely diminishes one's ability to swallow and enhances possible aspiration. I used to be an ER tech and have swallowed viscous lidocaine on several occasions when my oropharynx was sore from coughing etc. Very potent anesthetic.

What strikes me as a little odd is that this is being used for NGT insertions. It is not like inhaled lidocaine enters the esophagus......Unless you are just trying to blunt the gag reflex in the hypopharynx. Hmmmmmmm.

Methemoglobinemia is a unique development. Once you see it, you will never forget it. Several indicators can point the process out, but the gold standard for diagnosis is an ABG. Ever seen chocolate milk arterial blood? I have an awesome powerpoint concerning this, pm me if you are interested.

Also, when the patient can cooperate and swallow, the tube goes down a lot easier. Superficially sounds nice but don't think its good practice.

[MajorDomo]

When I am feeling nice, I tend to get the MD to order it prior to NG placement and nasal packing. Just remember to tell the pt to breath in through the nose and out the mouth. I have also used it for alert nasal intubations and for common sore throats. Works very nicely for each use so far.

MajorDomo

[susi_q]

Question then ... why have them breath thru their nose? Do they hold the neb in front of their nose? If the neb is in their mouth and they are nose breathing ... it would still carry to Lido to their lungs wouldn't it?? Just a might confused. Thanks.

[canoehead, BSN, RN]

The tube is going in their nose. If they mouth breathe the med goes in their mouth.

[Gompers, BSN, RN]

Question then ... why have them breath thru their nose? Do they hold the neb in front of their nose? If the neb is in their mouth and they are nose breathing ... it would still carry to Lido to their lungs wouldn't it?? Just a might confused. Thanks.

You don't want the Lidocaine to numb the lungs, you want it to numb the nasal tissue so that tube placement in the nares isn't as painful. By nose-breathing, the majority of the lidocaine hits the nasal tissue first and has the most effect there.

[MajorDomo]

Instead of using the normal neb "peace pipe," I usually switch over to a neb mask, sorry for the confusion.

MajorDomo

[NRSKarenRN, BSN, RN]

Another helpful tip learned at allnurses....THANKS!