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LETTER TO THE EDITOR

Aerosolized Lidocaine for Relief of Extubation Laryngospasm

Department of Anesthesiology; Sahel General Hospital; Beirut, Lebanon; doczeidan{at}hotmail.com (Zeidan, Halabi) Department of Anesthesiology; American University of Beirut Medical Center; Beirut, Lebanon (Baraka)

To the Editor:

Topical and/or IV lidocaine has been previously reported as effective to control laryngospasm (1). The following case report shows that an aerosolized lidocaine can also successfully control partial tracheal extubation laryngospasm.

A 28-yr-old woman, primigravida, was admitted for cesarean delivery. A rapid sequence induction was performed using propofol and succinylcholine, followed by cisatracurium. Trachea was intubated using a 7.0-mm (inner diameter) cuffed tube. After surgery, neostigmine 0.05 mg/kg and atropine 0.02 mg/kg were injected IV to reverse the residual muscular blockade. The trachea was extubated when the patient was fully awake. After extubation, the patient developed partial laryngospasm and Spo₂ decreased to 86%. A mixture of 5 mL of 2% lidocaine without epinephrine with equivolume of 0.9% normal saline was nebulized by 100% oxygen. A few minutes later, the patient showed a complete relief of laryngospasm and oxygen saturation increased to 100%.

In obstetric anesthesia anatomical changes associated with pregnancy, as well as nasal congestion and pharyngeal edema, may exacerbate the risk of hypoxemia after extubation laryngospasm (2). Previous reports have shown that topical lidocaine can abolish laryngeal chemoreflex and mechanoreflex (3). Our report shows that an aerosolized lidocaine may also depress the laryngeal reflexes and, hence, can be used to control partial extubation laryngospasm. The technique may not be advisable in patients with full stomach.

References

1. Koc C, Kocaman F, Aygenc E, et al. The use of preoperative lidocaine to prevent stridor and laryngospasm after tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 1998;118:880–2.[Web of Science][Medline]
2. Pilkington S, Carli F, Dakin MJ, et al. Increase in Mallampati score during pregnancy. Br J Anaesth 1995;74:638–42.[Abstract/Free Full Text]
3. McCulloch TM, Flint PW, Richardson MA, Bishop MJ. Lidocaine effects on the laryngeal chemoreflex, mechanoreflex, and afferent electrical stimulation reflex. Ann Otol Rhinol Laryngol. 1992;101:583–9.[Web of Science][Medline]

This Article 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 Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Zeidan, A. Articles by Baraka, A. Search for Related Content PubMed PubMed Citation Articles by Zeidan, A. Articles by Baraka, A.