Topical lidocaine reduces the risk of perioperative airway complications in children with upper respiratory tract infections

Abstract

Purpose: To determine the effect of topically applied lidocaine on perioperative airway complications when using a laryngeal mask airway device (LMAD) in children either with or without a history of recent or ongoing upper respiratory tract infection (URI). Methods: In a randomized controlled double-blind trial, 34 children with a history of recent or ongoing URI and 32 non-URI children- all of whom were younger than age ten and scheduled to undergo minor surgical procedures-were randomly assigned to either a lidocaine or a placebo group. In the lidocaine group, an LMAD was lubricated with lidocaine gel before insertion, and a clear lubricating gel was used in the placebo group. The following data were recorded after standardized anesthesia induction and airway management: postoperative complications, such as coughing, desaturation, laryngospasm, and increased oral secretions, as well as length of stay in the postanesthetic recovery unit. Results: Children with URI had a lower overall perioperative complication rate if they received a lidocaine gel (35%) rather than placebo (94%) (P < 0.01). Also, the incidence of postoperative coughing was less (12% vs 53%; P = 0.03). In non-URI patients, lidocaine did not significantly reduce the rate of airway complications compared with placebo (17% vs 24%, respectively). Conclusion: Lubrication of the LMAD with lidocaine gel reduces the incidence of airway complications in children with an upper respiratory tract infection. © 2010 Canadian Anesthesiologists' Society.