Lidocaine pretreatment during intubation

20 Oct

CONCEPT:
–intubation is associated with transient increase in BP & heart rate, due to brief catecholamine surge after messing with the larynx (probably)
–this surge can result in increased ICP, which is not great for head injury/head bleed patients
–lidocaine pretreatment can help blunt the rise in ICP

EVIDENCE:
–lidocaine shown to blunt increased ICP during endotrach suctioning, but may not directly apply to ED setting (rapid sequence intubation)
–review (linked below) “could find no evidence that in acute traumatic head injury pretreatment with IV lignocaine/lidocaine before a RSI reduces ICP or improves neurological outcome”

10-SECOND TAKEAWAY:
–RSI may cause brief increase ICP
–lidocaine pretreat (1.5mg/kg) for RSI supposed to help blunt this response
–not exactly a mountain of proof this works

QUICK TANGENT:
–fentanyl might be an alternative (1-3mcg/kg), if the BP can handle it

Reference(s): our canadian bretheren, review article, uptodate: “Pretreatment agents for rapid sequence intubation in adults”

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