Does topical lidocaine before tracheal intubation attenuate airway responses in children? An observational audit
Background: The use of topical lidocaine, applied to the airways with various administration techniques, is common practice in pediatric anesthesia in many institutions. However, it remains unclear whether these practices achieve their intended goal of reducing the risk of perioperative respiratory...
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| Veröffentlicht in: | Pediatric anesthesia 2012-04, Vol.22 (4), p.345-350 |
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| creator | Hamilton, Nigel D. Hegarty, Mary Calder, Alyson Erb, Thomas O. von Ungern-Sternberg, Britta S. |
| description | Background: The use of topical lidocaine, applied to the airways with various administration techniques, is common practice in pediatric anesthesia in many institutions. However, it remains unclear whether these practices achieve their intended goal of reducing the risk of perioperative respiratory adverse events (PRAE) in children undergoing elective endotracheal intubation without neuromuscular blockade (NMB). The relative frequency of PRAE (laryngospasm, coughing, desaturation |
| doi_str_mv | 10.1111/j.1460-9592.2011.03772.x |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_926154340</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3958257151</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5252-672c277d7098705bf230d037c910a4b0fb79d1c9e8c7d9d71a907460e5febc183</originalsourceid><addsrcrecordid>eNqNkU9v1DAQxSMEon_gKyBLHDgl2E5sxweEVoUuSFWpRBESF8uxJ6qXbBxsh-5-e5xu2QMnfPFI837PnnlFgQiuSD5vNxVpOC4lk7SimJAK10LQavekOD02nuaaMFYy3rCT4izGDcakppw-L04opYS0XJwW0wcPESU_OaMHNDjrjXYjoA56HwCloM0d5I4b09zp5PyIdEowzjoB0i7c6z0KECc_xuzjRmTu3GADjO_RakS-ixB-P2DZQ8_WpRfFs14PEV4-3ufFt8uPtxefyqsv688Xq6vSMMpoyQU1VAgrsGwFZl1Pa2zzlEYSrJsO952QlhgJrRFWWkG0xCKPDqyHzpC2Pi_eHHyn4H_NEJPaumhgGPQIfo5KUk5YUzc4K1__o9z4OeQPR0UE520t2pZmVXtQmeBjDNCrKbitDntFsFpCURu17F4tu1dLKOohFLXL6KvHB-ZuC_YI_k0hC94dBPdugP1_G6ub1fVSZb488C4m2B15HX6q7C6Y-n69VuLmFuM1_6G-1n8AVXyqiA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1766837882</pqid></control><display><type>article</type><title>Does topical lidocaine before tracheal intubation attenuate airway responses in children? An observational audit</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Hamilton, Nigel D. ; Hegarty, Mary ; Calder, Alyson ; Erb, Thomas O. ; von Ungern-Sternberg, Britta S.</creator><creatorcontrib>Hamilton, Nigel D. ; Hegarty, Mary ; Calder, Alyson ; Erb, Thomas O. ; von Ungern-Sternberg, Britta S.</creatorcontrib><description>Background: The use of topical lidocaine, applied to the airways with various administration techniques, is common practice in pediatric anesthesia in many institutions. However, it remains unclear whether these practices achieve their intended goal of reducing the risk of perioperative respiratory adverse events (PRAE) in children undergoing elective endotracheal intubation without neuromuscular blockade (NMB). The relative frequency of PRAE (laryngospasm, coughing, desaturation <95%) associated with no use of topical airway lidocaine (TAL), with TAL sprayed directly onto the vocal cords, and TAL administered blindly into the pharynx was assessed.
Methods: This prospective audit involved 1000 patients undergoing general anesthesia with elective endotracheal intubation without NMB. Patients with suspected difficult airways or undergoing airway surgery were excluded. The use of TAL and the mode of administration were recorded. Respiratory adverse events were recorded in the perioperative period.
Results: Two hundred and fifty‐four patients had the vocal cords sprayed under direct vision, 236 had lidocaine blindly dripped into the pharynx, and 510 received no TAL. The mean age and known risk factors for PRAE (asthma, recent upper respiratory tract infection (≤2 weeks), passive smoking, hayfever, past or present eczema, nocturnal dry cough) were similar among the groups. The proportion of patients with desaturation (<95%) between induction of anesthesia and discharge from the recovery room was higher in the two groups who received TAL (data combined for all patients receiving lidocaine regardless of administration method, P = 0.01) compared to those who received no TAL. No difference in the rates of laryngospasm (P = 0.13) or cough (P = 0.07) was observed among the groups. There was no difference in the rates of PRAE between the groups given TAL directly onto the vocal cords and in those whom received TAL blindly.
Conclusions: The incidence of desaturation was higher in patients receiving TAL compared with children who did not. This association should perhaps be considered when contemplating the use of this technique.</description><identifier>ISSN: 1155-5645</identifier><identifier>EISSN: 1460-9592</identifier><identifier>DOI: 10.1111/j.1460-9592.2011.03772.x</identifier><identifier>PMID: 22211867</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Administration, Topical ; Adolescent ; adverse events - complications ; Anesthetics, Local - administration & dosage ; Anesthetics, Local - therapeutic use ; Child ; child - airway ; Child, Preschool ; complications - respiration ; Cough - epidemiology ; Cough - etiology ; Female ; Humans ; Infant ; Infant, Newborn ; Intubation ; Intubation, Intratracheal - adverse effects ; Intubation, Intratracheal - methods ; Laryngismus - epidemiology ; Laryngismus - etiology ; Larynx ; Lidocaine - administration & dosage ; Lidocaine - therapeutic use ; local anesthetics - drugs ; Male ; Medical Audit ; Musicians & conductors ; Oxygen - blood ; Pharynx ; Prospective Studies ; Respiratory Mechanics ; Risk Factors ; techniques - airway ; Vocal Cords</subject><ispartof>Pediatric anesthesia, 2012-04, Vol.22 (4), p.345-350</ispartof><rights>2011 Blackwell Publishing Ltd</rights><rights>2011 Blackwell Publishing Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5252-672c277d7098705bf230d037c910a4b0fb79d1c9e8c7d9d71a907460e5febc183</citedby><cites>FETCH-LOGICAL-c5252-672c277d7098705bf230d037c910a4b0fb79d1c9e8c7d9d71a907460e5febc183</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1460-9592.2011.03772.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1460-9592.2011.03772.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22211867$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hamilton, Nigel D.</creatorcontrib><creatorcontrib>Hegarty, Mary</creatorcontrib><creatorcontrib>Calder, Alyson</creatorcontrib><creatorcontrib>Erb, Thomas O.</creatorcontrib><creatorcontrib>von Ungern-Sternberg, Britta S.</creatorcontrib><title>Does topical lidocaine before tracheal intubation attenuate airway responses in children? An observational audit</title><title>Pediatric anesthesia</title><addtitle>Paediatr Anaesth</addtitle><description>Background: The use of topical lidocaine, applied to the airways with various administration techniques, is common practice in pediatric anesthesia in many institutions. However, it remains unclear whether these practices achieve their intended goal of reducing the risk of perioperative respiratory adverse events (PRAE) in children undergoing elective endotracheal intubation without neuromuscular blockade (NMB). The relative frequency of PRAE (laryngospasm, coughing, desaturation <95%) associated with no use of topical airway lidocaine (TAL), with TAL sprayed directly onto the vocal cords, and TAL administered blindly into the pharynx was assessed.
Methods: This prospective audit involved 1000 patients undergoing general anesthesia with elective endotracheal intubation without NMB. Patients with suspected difficult airways or undergoing airway surgery were excluded. The use of TAL and the mode of administration were recorded. Respiratory adverse events were recorded in the perioperative period.
Results: Two hundred and fifty‐four patients had the vocal cords sprayed under direct vision, 236 had lidocaine blindly dripped into the pharynx, and 510 received no TAL. The mean age and known risk factors for PRAE (asthma, recent upper respiratory tract infection (≤2 weeks), passive smoking, hayfever, past or present eczema, nocturnal dry cough) were similar among the groups. The proportion of patients with desaturation (<95%) between induction of anesthesia and discharge from the recovery room was higher in the two groups who received TAL (data combined for all patients receiving lidocaine regardless of administration method, P = 0.01) compared to those who received no TAL. No difference in the rates of laryngospasm (P = 0.13) or cough (P = 0.07) was observed among the groups. There was no difference in the rates of PRAE between the groups given TAL directly onto the vocal cords and in those whom received TAL blindly.
Conclusions: The incidence of desaturation was higher in patients receiving TAL compared with children who did not. This association should perhaps be considered when contemplating the use of this technique.</description><subject>Administration, Topical</subject><subject>Adolescent</subject><subject>adverse events - complications</subject><subject>Anesthetics, Local - administration & dosage</subject><subject>Anesthetics, Local - therapeutic use</subject><subject>Child</subject><subject>child - airway</subject><subject>Child, Preschool</subject><subject>complications - respiration</subject><subject>Cough - epidemiology</subject><subject>Cough - etiology</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Intubation</subject><subject>Intubation, Intratracheal - adverse effects</subject><subject>Intubation, Intratracheal - methods</subject><subject>Laryngismus - epidemiology</subject><subject>Laryngismus - etiology</subject><subject>Larynx</subject><subject>Lidocaine - administration & dosage</subject><subject>Lidocaine - therapeutic use</subject><subject>local anesthetics - drugs</subject><subject>Male</subject><subject>Medical Audit</subject><subject>Musicians & conductors</subject><subject>Oxygen - blood</subject><subject>Pharynx</subject><subject>Prospective Studies</subject><subject>Respiratory Mechanics</subject><subject>Risk Factors</subject><subject>techniques - airway</subject><subject>Vocal Cords</subject><issn>1155-5645</issn><issn>1460-9592</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU9v1DAQxSMEon_gKyBLHDgl2E5sxweEVoUuSFWpRBESF8uxJ6qXbBxsh-5-e5xu2QMnfPFI837PnnlFgQiuSD5vNxVpOC4lk7SimJAK10LQavekOD02nuaaMFYy3rCT4izGDcakppw-L04opYS0XJwW0wcPESU_OaMHNDjrjXYjoA56HwCloM0d5I4b09zp5PyIdEowzjoB0i7c6z0KECc_xuzjRmTu3GADjO_RakS-ixB-P2DZQ8_WpRfFs14PEV4-3ufFt8uPtxefyqsv688Xq6vSMMpoyQU1VAgrsGwFZl1Pa2zzlEYSrJsO952QlhgJrRFWWkG0xCKPDqyHzpC2Pi_eHHyn4H_NEJPaumhgGPQIfo5KUk5YUzc4K1__o9z4OeQPR0UE520t2pZmVXtQmeBjDNCrKbitDntFsFpCURu17F4tu1dLKOohFLXL6KvHB-ZuC_YI_k0hC94dBPdugP1_G6ub1fVSZb488C4m2B15HX6q7C6Y-n69VuLmFuM1_6G-1n8AVXyqiA</recordid><startdate>201204</startdate><enddate>201204</enddate><creator>Hamilton, Nigel D.</creator><creator>Hegarty, Mary</creator><creator>Calder, Alyson</creator><creator>Erb, Thomas O.</creator><creator>von Ungern-Sternberg, Britta S.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201204</creationdate><title>Does topical lidocaine before tracheal intubation attenuate airway responses in children? An observational audit</title><author>Hamilton, Nigel D. ; Hegarty, Mary ; Calder, Alyson ; Erb, Thomas O. ; von Ungern-Sternberg, Britta S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5252-672c277d7098705bf230d037c910a4b0fb79d1c9e8c7d9d71a907460e5febc183</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Administration, Topical</topic><topic>Adolescent</topic><topic>adverse events - complications</topic><topic>Anesthetics, Local - administration & dosage</topic><topic>Anesthetics, Local - therapeutic use</topic><topic>Child</topic><topic>child - airway</topic><topic>Child, Preschool</topic><topic>complications - respiration</topic><topic>Cough - epidemiology</topic><topic>Cough - etiology</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Intubation</topic><topic>Intubation, Intratracheal - adverse effects</topic><topic>Intubation, Intratracheal - methods</topic><topic>Laryngismus - epidemiology</topic><topic>Laryngismus - etiology</topic><topic>Larynx</topic><topic>Lidocaine - administration & dosage</topic><topic>Lidocaine - therapeutic use</topic><topic>local anesthetics - drugs</topic><topic>Male</topic><topic>Medical Audit</topic><topic>Musicians & conductors</topic><topic>Oxygen - blood</topic><topic>Pharynx</topic><topic>Prospective Studies</topic><topic>Respiratory Mechanics</topic><topic>Risk Factors</topic><topic>techniques - airway</topic><topic>Vocal Cords</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hamilton, Nigel D.</creatorcontrib><creatorcontrib>Hegarty, Mary</creatorcontrib><creatorcontrib>Calder, Alyson</creatorcontrib><creatorcontrib>Erb, Thomas O.</creatorcontrib><creatorcontrib>von Ungern-Sternberg, Britta S.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hamilton, Nigel D.</au><au>Hegarty, Mary</au><au>Calder, Alyson</au><au>Erb, Thomas O.</au><au>von Ungern-Sternberg, Britta S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does topical lidocaine before tracheal intubation attenuate airway responses in children? An observational audit</atitle><jtitle>Pediatric anesthesia</jtitle><addtitle>Paediatr Anaesth</addtitle><date>2012-04</date><risdate>2012</risdate><volume>22</volume><issue>4</issue><spage>345</spage><epage>350</epage><pages>345-350</pages><issn>1155-5645</issn><eissn>1460-9592</eissn><abstract>Background: The use of topical lidocaine, applied to the airways with various administration techniques, is common practice in pediatric anesthesia in many institutions. However, it remains unclear whether these practices achieve their intended goal of reducing the risk of perioperative respiratory adverse events (PRAE) in children undergoing elective endotracheal intubation without neuromuscular blockade (NMB). The relative frequency of PRAE (laryngospasm, coughing, desaturation <95%) associated with no use of topical airway lidocaine (TAL), with TAL sprayed directly onto the vocal cords, and TAL administered blindly into the pharynx was assessed.
Methods: This prospective audit involved 1000 patients undergoing general anesthesia with elective endotracheal intubation without NMB. Patients with suspected difficult airways or undergoing airway surgery were excluded. The use of TAL and the mode of administration were recorded. Respiratory adverse events were recorded in the perioperative period.
Results: Two hundred and fifty‐four patients had the vocal cords sprayed under direct vision, 236 had lidocaine blindly dripped into the pharynx, and 510 received no TAL. The mean age and known risk factors for PRAE (asthma, recent upper respiratory tract infection (≤2 weeks), passive smoking, hayfever, past or present eczema, nocturnal dry cough) were similar among the groups. The proportion of patients with desaturation (<95%) between induction of anesthesia and discharge from the recovery room was higher in the two groups who received TAL (data combined for all patients receiving lidocaine regardless of administration method, P = 0.01) compared to those who received no TAL. No difference in the rates of laryngospasm (P = 0.13) or cough (P = 0.07) was observed among the groups. There was no difference in the rates of PRAE between the groups given TAL directly onto the vocal cords and in those whom received TAL blindly.
Conclusions: The incidence of desaturation was higher in patients receiving TAL compared with children who did not. This association should perhaps be considered when contemplating the use of this technique.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>22211867</pmid><doi>10.1111/j.1460-9592.2011.03772.x</doi><tpages>6</tpages></addata></record> |
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| subjects | Administration, Topical Adolescent adverse events - complications Anesthetics, Local - administration & dosage Anesthetics, Local - therapeutic use Child child - airway Child, Preschool complications - respiration Cough - epidemiology Cough - etiology Female Humans Infant Infant, Newborn Intubation Intubation, Intratracheal - adverse effects Intubation, Intratracheal - methods Laryngismus - epidemiology Laryngismus - etiology Larynx Lidocaine - administration & dosage Lidocaine - therapeutic use local anesthetics - drugs Male Medical Audit Musicians & conductors Oxygen - blood Pharynx Prospective Studies Respiratory Mechanics Risk Factors techniques - airway Vocal Cords |
| title | Does topical lidocaine before tracheal intubation attenuate airway responses in children? An observational audit |
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