Atomised lidocaine for airway topical anaesthesia in the morbidly obese: 1%
compared with 2%.
Author(s): Woodruff C, Wieczorek PM, Schricker T, Vinet B, Backman SB.
Affiliation(s): Department of Anesthesia, MUHC-Royal Victoria Hospital, Montreal, QC, Canada.
Publication date & source: 2010, Anaesthesia. , 65(1):12-7
Airway anaesthesia using atomised lidocaine for awake oral fibreoptic intubation
in morbidly obese patients was evaluated using two doses of local anaesthetic. In
this randomised, blinded prospective study, 40 ml of atomised 1% (n = 11) or 2%
(n = 10) lidocaine was administered with high oxygen flow as carrier. Outcomes
included time for intubation, patient tolerance to airway manipulation,
haemodynamic parameters, the bronchoscopist's overall satisfaction, and serial
serum lidocaine concentrations. Patients receiving lidocaine 1% had a longer mean
(SD) time from the start of topicalisation to tracheal tube cuff inflation than
those receiving lidocaine 2% (8.6 (0.9) min vs 6.9 (0.5) min, respectively; p <
0.05). Patients in the 1% cohort demonstrated increased responses to airway
manipulation (p < 0.0001), reflecting lower bronchoscopist's satisfaction scores
(p < 0.03). Haemodynamic responses to topicalisation and airway manipulation were
similar in both groups. Peak plasma concentration was lower in the 1% group (mean
(SD) 1.4 (0.3) and 3.8 (0.5) microg.ml(-1), respectively; p < 0.001). Airway
anaesthesia using atomised lidocaine for awake oral fibreoptic intubation in the
morbidly obese is efficacious, rapid and safe. Compared with lidocaine 1%, the 2%
dose provides superior intubating conditions.
Erratum in
Anaesthesia. 2010 Feb;65(2):222.
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