Hello to all and those who sent questions and comments regarding nebulized
lidocaine (Paul Robinson, George Zaharian, Larry Reynolds, and Muslim
<<what is the dose of neubulized lidocaine?>>
2% lidocaine = 2 gms/100cc = 2000 mg/100cc = 20 mg/cc. I try not to exceed
2-4 mg/kg in 20-30 minute period.
<<Are there any age limitation?>>
<<Can you give reference on that?>>
there is always one....here are places to start.
Sklar BZ, Lurie S, Ezi T, et al: Lidocaine inhalation attenuates the
circulatory response to laryngoscopy and endotracheal intubation. J Clin
Lev R, Rosen: Prophylactic lidocaine use preintubation: A review. J Emerg Med
<<However, with the gag reflex temporarily gone, how does one protect the
airway, should the child become nauseated??>>
I am using this to abort severe coughing paroxysms under my observation in the
ED. If they just ate a Big Mac and are nauseated, I am less likely to use it.
Loss of airway reflexes are ALWAYS of concern with the use of any sedatives or
topical hypopharyngeal anesthetics (viscous lidocaine for sore throat?)
Most kids with respiratory distress have developed it over a period of 1 to 2
hours and usually have not eaten or have vomited before I get to them. If they
are severely nauseous, I will not do it. It is interesting though, vomiting
seems to break some asthmatics. Is it due to catecholamine release
associated with vomiting?
<<At what point in time do you make the decision to tube??>>
I NEVER tube an asthmatic or COPD patient unless they are getting lethargic
and are unable to oxygenate. I dont care what their CO2 is unless they are
getting CO2 narcosis and getting into trouble with impending respiratory
failure. A struggling, fighting asthamtic is someone who has the strength to
hang in there a bit longer for sympathomimetics to work.
Please remember - this is for (1) awake patients who just cannot stop
coughing to the point that everyone including the patient themselves are
panicking and hyperventilating. (2) awake intubations or those in whom you
want to suppress the gag/cough reflex.
Have fun out there.
Mike Gerardi, M.D.
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