Investigation of Efficacy of Lidocaine Spray for Sedated Esophagogastroduodenoscopy in Children / 대한소아소화기영양학회지

PURPOSE: Our aim in this study is to investigate efficacy of topical lidocaine spray for sedated esophagogastroduodenoscopy (EGD) in children. METHODS: The endoscopy of children aged between 3-18 years who underwent EGD in our endoscopy unit. Intravenous (IV) midazolam and ketamine were used for sedation. Prior to sedation, endoscopy nurse applied topical lidocaine 10% with pump spray at 1 mg/kg dose in group 1, and distilled water via identically scaled pump spray in group 2, in a double blinded fashion. RESULTS: Sedation was not applied in 24.1% of the cases in topical lidocaine spray group (LS group) and in 5.7% of the cases in distilled water spray group (DS group). Gag reflex was observed in 6.5% of cases in LS group and 33.3% of cases in DS group (p=0.024), increased oral secretion was observed in 9.3% of cases in LS group and 51.7% of cases in DS group (p=0.038), sore throat was observed in 3.7% of cases in LS group and 35.6% of cases in DS group (p=0.019) and the difference was statistically significant. CONCLUSION: The study showed that topical pharyngeal lidocaine reduces both requirement and amount of IV sedation before EGD in children and sore throat, gag reflex and decreased oral secretion increase.

Difference between Cardiovascular Response Blockades by Orolaryngeal and Nasal Lidocaine Sprays during Nasotracheal Intubation under Direct Laryngoscopy / 대한마취과학회지

BACKGROUND: Cardiovascular response elicited by mechanical stimulation of airways varies depends on the site of stimulation. The purpose of this study was to compare cardiovascular pressor responses to direct laryngoscopic nasotracheal intubation, when lidocaine was applied topically as either a nasal spray or an orolaryngeal spray before the induction of anesthesia. METHODS: Forty-six healthy adult patients were randomly allocated to two groups according to the site of the lidocaine spray before the induction of the anesthesia. Group N (nasal spray group, n = 23) received a 10% lidocaine nasal spary using a pump-metered spray (3 times into each nostril), and Group O (orolaryngeal spray group, n = 23) received the same dose and preparation in a sitting position on inspiration. After induction of anesthesia, a nasotracheal tube was inserted through a nostril. Hemodynamic data were recorded in the ward (control), after lidocaine spray, after the induction of anesthesia but before intubation, and immediately and 1min after intubation. RESULTS: Nasotracheal intubation caused a significant increase in heart rate in both groups, but a significant increase in blood pressure occurred in group O only. Rises in systolic, diastolic and mean blood pressure were significantly higher in group O than that in group N immediately and 1 min after nasotracheal intubation. CONCLUSION: Topical lidocaine administered as a nasal spray before the induction of anesthesia was found to be effective at reducing but not abolishing tachycardia response to direct laryngoscopy and nasotracheal intubation.

Plasma Lidocaine Concentration and Hemodynamic Effect after 10% Lidocaine Spray on Laryngopharyngeal and Intratracheal Site during the Endotracheal Intubation / 대한마취과학회지

BACKGROUND: To minimize hemodynamic responses to laryngoscopy and endotracheal intubation, 10% lidocaine spray to laryngopharyngeal area seems to be favorable. The aim of this study was to evaluate plasma concentration and hemodynamic responses following different dose of 10% lidocaine spray before laryngoscopic intubation. METHODS: Fifteen patients (ASA I, II) were randomly allocated. Group I (n = 5) patients were received saline spray for control, group II (n = 5) patients were received 1 mg/kg 10% lidocaine spray on laryngopharynx before induction of anesthesia and received 1 mg/kg 10% lidocaine topical spray to trachea under direct laryngoscopic view one minute before intubation, group III (n = 5) patients were received 1.5 mg/kg lidocaine spray. Hemodynamic response were measured at baseline, postspray 1 min, postintubation, postspray 2, 4, 6, 8, 10 min. Arterial blood samples for lidocaine concentration analysis were obtained at baseline and 2, 4, 6, 8, 10, 20, 30, 60, 120 minutes after larygopharyngeal and intratracheal administration of lidocaine. RESULTS: The highest lidocaine concentrations in arterial blood were 1.76 +/- 0.52microgram/ml for group II, 2.86 +/- 0.40microgram/ml for group III (mean +/- SD) 2 to 10 minutes after laryngopharyngeal and intratracheal administration. There weren't any definitive toxic symptoms observed during the study. Hemodynamic responses of group II and III were not satisfactory but remarkably stable compared with group I. There were no differences between group II and III. CONCLUSION: Sympathetic responses after 2-3 mg/kg lidocaine spray on laryngopharynx are favorably but not sufficiently attenuated during endotracheal intubation.

The Effects of 10% Lidocaine Spray on the Pharyngolarynx during the Endotracheal Intubation without Muscle Relaxants? / 대한마취과학회지

BACKGROUND: Tracheal intubation is usually carried out under a combination of general anesthesia and muscle relaxation. Recent sutdies have found satisfactory conditions for intubation of the trachea without using muscle relaxants. However, these studies have used large amounts of propofol or expensive opioids like alfentanil and remifentanil. In this study, we evaluated intubation conditions and success rate with midazolam, fentanyl, propofol and either 10% lidocaine applied topically into the larynx and trachea or not. METHODS: Forty patients of ASA class I or II were randomly allocated to one of two groups. All patients received glycopyrrolate 0.2 mg, midazolam 0.03 mg/kg and fentanyl 2 mcg/kg IV before induction of anesthesia and propofol 2 mg/kg IV for induction of anesthesia. Group I patients (n = 20) received 10% lidocaine into the larynx and trachea topically, and group II patients (n = 20) did not. After loss of the eyelid reflex, laryngoscopy and endotracheal intubation were attempted and airway conditions were graded. The success rate of intubation was evaluated. RESULTS: Intubation without a muscle relaxant was possible in 19 of 20 (95%) patients in group I and 8 of 20 (40%) patients in group II. There were no significant differences in scoring criteria for various airway conditions such as jaw tone, vocal cord exposure and cord position. CONCLUSIONS: Induction of anesthesia with midazolam 0.03 mg/kg, fentanyl 2 mcg/kg and propofol 2 mg/kg combined with 2 ml of 10% lidocaine spray into the larynx and trachea offered a satisfactory success rate of intubation without muscle relaxants.