Inhaled albuterol, but not intravenous lidocaine, protects against intubation-induced bronchoconstriction in asthma.
BACKGROUND
The ability of intravenous lidocaine to prevent intubation-induced bronchospasm is unclear. The authors performed a prospective, randomized, double-blind, placebo-controlled trial to test the ability of intravenous lidocaine and inhaled albuterol to attenuate airway reactivity after tracheal intubation in asthmatic patients undergoing general anesthesia.


METHODS
Sixty patients were randomized to receive either 1.5 mg/kg intravenous lidocaine or saline, 3 min before tracheal intubation. An additional 50 patients were randomized to receive 4 puffs of inhaled albuterol or placebo 15-20 min before tracheal intubation. Anesthesia was induced with propofol. Immediately after intubation and at 5-min intervals, transpulmonary pressure and airflow were recorded, and lower pulmonary resistance (RL) was calculated. Isoflurane was administered after the initial two measurements to assess reversibility of bronchoconstriction. A bronchoconstrictor response to intubation was defined as RL greater than or equal to 5 cm H2O. l-1. s-1 in the first two measurements after intubation and RL subsequently decreasing by 50% or more after isoflurane.


RESULTS
The lidocaine and placebo groups were not different in the peak RL before administration of isoflurane (8.2 cm H2O. l-1. s-1 vs. 7.6 cm H2O. l-1. s-1) or frequency of airway response to intubation (lidocaine 6 of 30 vs. placebo 5 of 27). In contrast, the albuterol group had lower peak RL (5.3 cm H2O. l-1. s-1 vs. 8.9 cm H2O. l-1. s-1; P < 0.05) and a lower frequency of airway response (1 of 25 vs. 8 of 23; P < 0.05) than the placebo group.


CONCLUSIONS
Inhaled albuterol blunted airway response to tracheal intubation in asthmatic patients, whereas intravenous lidocaine did not.
Maslow
A D
AD
Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. amaslow@lifespan.org
Regan
M M
MM
Israel
E
E
Darvish
A
A
Mehrez
M
M
Boughton
R
R
Loring
S H
SH
D000280:Administration, Inhalation; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage*; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001249:Asthma / Q000150:complications*; D001986:Bronchial Spasm / Q000209:etiology / Q000517:prevention & control*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007530:Isoflurane / Q000008:administration & dosage; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D010919:Placebos; D011446:Prospective Studies
D018685:Anesthetics, Inhalation; D000779:Anesthetics, Local; D001993:Bronchodilator Agents; D010919:Placebos; D008012:Lidocaine; D007530:Isoflurane; D000420:Albuterol