The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children *

We studied the effect of intravenous lidocaine on laryngeal and respiratory reflex responses in children anaesthetised with sevoflurane. We tested the hypothesis that the incidence of laryngospasm evoked by laryngeal stimulation is temporarily diminished after the administration of lidocaine. Forty children, aged between 25 and 84 months, were anaesthetised with sevoflurane and breathed spontaneously through a laryngeal mask airway. Respiratory reflex responses were elicited by spraying distilled water onto the laryngeal mucosa at three time intervals: (i) before lidocaine was administered (baseline); (ii) at 2 min and (iii) at 10 min following the intravenous administration of a bolus of lidocaine 2 mg.kg−1. A blinded reviewer assessed the evoked responses. The incidence of laryngospasm was reduced from 38% at baseline to 15% 2 min after lidocaine administration (p < 0.02) and 18% 10 min after lidocaine administration (p = 0.10). We conclude that intravenous lidocaine significantly reduced the incidence of laryngospasm but that the effect was short‐lived.

[1]  A. Perruchoud Exploring laryngeal reflexes in anaesthetised children – the research ethics committee's point of view , 2013, Anaesthesia.

[2]  A. Durward Research in children and ethical limits: the water laryngospasm challenge , 2013, Anaesthesia.

[3]  S. Yentis,et al.  Small patients, big ethics , 2013, Anaesthesia.

[4]  T. Erb,et al.  Exploring laryngeal reflexes in anaesthetised children – the investigators’ point of view , 2013, Anaesthesia.

[5]  G. Rosner,et al.  Fentanyl Does Not Reduce the Incidence of Laryngospasm in Children Anesthetized with Sevoflurane , 2010, Anesthesiology.

[6]  T. Erb,et al.  Laryngeal mask airway and tracheal tube cuff pressures in children: are clinical endpoints valuable for guiding inflation? , 2008, Anaesthesia.

[7]  John S Campos,et al.  Anesthesia-Related Cardiac Arrest in Children: Update from the Pediatric Perioperative Cardiac Arrest Registry , 2007, Anesthesia and analgesia.

[8]  M. Durieux,et al.  The effect of too much intravenous lidocaine on bispectral index. , 2006, Anesthesia and analgesia.

[9]  M. Chang,et al.  Lidocaine Does Not Prevent Bispectral Index Increases in Response to Endotracheal Intubation , 2006, Anesthesia and analgesia.

[10]  T. Erb,et al.  Respiratory Reflex Responses of the Larynx Differ between Sevoflurane and Propofol in Pediatric Patients , 2005, Anesthesiology.

[11]  T. Nishino,et al.  Airway Protective Reflexes Evoked by Laryngeal Instillation of Distilled Water Under Sevoflurane General Anesthesia in Children , 2005, Anesthesia and analgesia.

[12]  T. Nishino,et al.  Laryngeal Reflex before and after Placement of Airway Interventions: Endotracheal Tube and Laryngeal Mask Airway™ , 2005, Anesthesiology.

[13]  C. Keller,et al.  Pharyngolaryngeal, Neck, and Jaw Discomfort after Anesthesia with the Face Mask and Laryngeal Mask Airway at High and Low Cuff Volumes in Males and Females , 2000, Anesthesiology.

[14]  E. Figueredo,et al.  Laryngo-pharyngeal complaints after use of the laryngeal mask airway , 1999, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[15]  D. O. Warner Laryngeal reflexes: exploring terra incognita. , 1998, Anesthesiology.

[16]  C. Koç,et al.  The use of Preoperative Lidocaine to Prevent Stridor and Laryngospasm after Tonsillectomy and Adenoidectomy , 1998, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[17]  T. Nishino,et al.  Upper Airway Reflexes during a Combination of Propofol and Fentanyl Anesthesia , 1998, Anesthesiology.

[18]  N. Bauman,et al.  Reflex laryngospasm induced by stimulation of distal esophageal afferents , 1994, The Laryngoscope.

[19]  R. Caplan,et al.  A Comparison of Pediatric and Adult Anesthesia Closed Malpractice Claims , 1993, Anesthesiology.

[20]  K. Ikeda,et al.  Airway irritation produced by volatile anaesthetics during brief inhalation: comparison of halothane, enflurane, isoflurane and sevoflurane , 1993, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[21]  M. Fujimori,et al.  Intravenous Lidocaine as a Suppressant of Coughing during Tracheal Intubation , 1985, Anesthesia and analgesia.

[22]  T. Wisborg,et al.  Does Intravenous Lidocaine Prevent Laryngospasm after Extubation in Children? , 1985, Anesthesia and analgesia.

[23]  B. Hallén,et al.  Laryngospasm During Anaesthesia. A Computer‐Aided Incidence Study in 136 929 Patients , 1984, Acta anaesthesiologica Scandinavica.

[24]  L. W. Andersen,et al.  Lidocaine given intravenously as a suppressant of cough and laryngospasm in connection with extubation after tonsillectomy. , 1983, Acta anaesthesiologica Scandinavica.

[25]  A. Baraka Intravenous lidocaine controls extubation laryngospasm in children. , 1978, Anesthesia and analgesia.

[26]  N. Benowitz,et al.  Clinical Pharmacokinetics of Lignocaine , 1978, Clinical pharmacokinetics.

[27]  R. Burney,et al.  Effects of Lidocaine on the Anesthetic Requirements for Nitrous Oxide and Halothane , 1977, Anesthesiology.

[28]  B. Fink THE ETIOLOGY AND TREATMENT OF LARYNGEAL SPASM , 1956, Anesthesiology.