This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (8) Citing Articles via Google Scholar Google Scholar Articles by Prengel, A. W. Articles by Steinbach, G. Search for Related Content PubMed PubMed Citation Articles by Prengel, A. W. Articles by Steinbach, G. Related Collections Airway Pharmacology

---

CRITICAL CARE AND TRAUMA

A Comparison of the Endotracheal Tube and the Laryngeal Mask Airway as a Route for Endobronchial Lidocaine Administration

Andreas W. Prengel, MD^*, Martin Rembecki, MD^*, Volker Wenzel, MD, and Gerald Steinbach, MD

*Department of Anesthesiology and Critical Care Medicine, Ruhr University, Bochum, Germany; Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria; and Department of Clinical Chemistry, University of Ulm, Ulm, Germany

Address correspondence and reprint requests to Andreas W. Prengel, MD, Department of Anesthesiology and Critical Care Medicine, Ruhr University, In der Schornau 23-25, 44892 Bochum, Germany. Address e-mail to Andreas.Prengel{at}ruhr-uni-bochum.de

Drug administration via the endotracheal tube is recommended as a second-line approach in emergency settings such as cardiac arrest. It is unknown what amount of drugs are absorbed when they are given through the laryngeal mask airway as compared with the endotracheal tube. We administered lidocaine at a dose of 2 mg/kg diluted in 10 mL normal saline to 20 anesthetized patients undergoing routine surgical procedures. Ten patients received lidocaine into the endotracheal tube and 10 patients received lidocaine into the laryngeal mask airway. Blood samples were taken for measurement of lidocaine plasma concentrations, and the pharmacokinetics were calculated. Therapeutic plasma concentrations (>1.4 µg/mL) could be achieved in 10 of 10 patients after endotracheal tube instillation but in only 4 of 10 patients after laryngeal mask instillation (P < 0.05). Peak lidocaine concentrations (2.47 and 1.09 µg/mL) (P < 0.05) and the area under the time versus plasma concentration curve (117.7 and 91.2 µg · min · mL^-1) (P < 0.05) were higher after lidocaine administration into the endotracheal tube than into the laryngeal mask airway. In conclusion, the laryngeal mask airway is not a reliable route for the recommended dose of endobronchial lidocaine administration compared with the endotracheal tube.

Implications: Drug absorption after lidocaine administration into the laryngeal mask airway is not sufficient to achieve therapeutic lidocaine plasma concentrations. IV drug administration should be used whenever the laryngeal mask is used in the cardiac arrest setting.

This article has been cited by other articles:

				Part 7.2: Management of Cardiac Arrest Circulation, December 13, 2005; 112(24_suppl): IV-58 - IV-66. [Full Text] [PDF]

				Part 4: Advanced Life Support Circulation, November 29, 2005; 112(22_suppl): III-25 - III-54. [Full Text] [PDF]