Lidocaine

 
 
 
 
Laryngoscopy and intubation can lead to tachacardia and hypertension, which may not present problems for the healthy individual, however for those with accompanying cardiovascular problems, these consequences may be life-threatening. Lidocaine and other local anesthetics are used to attenuate these conditions. Lidocaine acts as a vasodilator with direct results of smooth muscle relaxation (Forbes & Dally, 1970; Nagelhout & Zaglaniczny, 2001).

Lidocaine can be sprayed topically or it can be administered intravenously. Both administrations result in a blocking of sodium channels, a decrease in depolarization, a decrease in sympathetic nervous system stimulation, and a decrease in catecholamine release. This leads to a blunting of the side effects of endotracheal intubation (tachacardia and hypertension) (Morgan & Mikhail, 1996).

While research presents findings regarding the negative effects of laryngoscopy and endotracheal intubation, as well as positive effects of lidocaine use, it remains unclear as to which method of administration is more effective. Some have shown that both intravenous and topical use of lidocaine had positive effects, others have shown intravenous administration to be superior to topical administration, and still others have shown no protection from either type of administration (Laurito, Baughman, Becker, Polek, Riegler, & VadeBoncouer, 1988; Stoelting, 1977; Youngberg, Graybar, & Hutchings, 1983). P


     
 
 
 
    

 

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TER TWO Literature Review This review of the literature will present information relevant to the topic of effects of topical and intravenous administration of lidocaine on blunting increases in heart rate and blood pressure during laryngoscopy and intubation. Introduction 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 catechol

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