Lidocaine, Heart Rate and Blood Pressure

Increased heart rates and arterial blood pressure are commonly found following laryngoscopy and endotracheal intubation and these effects can result in increased danger for coronary-artery disease patients (Bidwal, Bidwal, Rogers, & Stanely, 1979; Hamill, Bedford, Weaver, & Colohan, 1981). Lidocaine administered to suppress these effects has been shown to be beneficial and has been used as a supplement to general anesthesia for years. Early studies demonstrated its positive effect of suppressing the cough reflex (Steinhaus & Gaskin, 1963), while Demczuk (1984) demonstrated that it also can depress the sinus node and result in sinus bradycardia. Research regarding mechanisms of action remain unclear. Takki, Tammisto, Nikki, and Jaattela (1972) found no changes in catecholamine levels during laryngoscopy, and yet Derbyshire, Chmielewski, Feli, Vater, Achola, and Smith (1983) found mean arterial pressure increases were related to increased plasma catecholamine concentrations in response to tracheal intubation.

Laryngoscopy and intubation can lead to tachacardia and hypertension. Laryngoscopy and intubation interrupt an individual's reflex action. Protective airway reflexes are in place and when violated they lead to tachycardia and hypertension. These responses

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however amounts of lidocaine used were 1.5 mg kg, and timing was 1, 2, and 3 minutes prior to laryngoscopy. Tam, Chung, and Campbell (1987) also studied timing of injection of IV lidocaine prior to tracheal intubation with 70 patients with no known hypertension. Patients received 1.5 mg/kg IV 1,2,3, and 5 minutes prior to intubation. The authors concluded that 1.5 mg/kg IV lidocaine given 3 minutes prior to intubation blunts increases in heart rate and blood pressure, and no protection is found at 1,2, or 5 minutes. Topical and Laryngotracheal Administration Derbyshire, Smith and Achola studied topical lidocaine, hypertension, and tachycardia related to laryngoscopy and intubation. Groups received 4% lidocaine 160 mg with Forrester Spray, 4%, 160 mg by Larying-o-jet, and saline; there was no differences between any groups at any stage, thus topical lidocaine was ineffective. Viegas and Stoelting (1975) studied lidocaine absorption after laryngotracheal administration in 12 patients without heart disease. A disposable cannula and syringe was used to administer 2mg/kg lidocaine. Findings showed that arterial-blood lidocaine concentrations of 2 to 5 ug/ml are needed for protective effects against ventricular dysrhythmias;
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