Hemodynamic response of lignocaine in laryngoscopy and intubation

Background: Laryngoscopy and tracheal intubation can associate with increased blood pressure and heart rate, increased risk of mortality and morbidity in high risk patients. Aim: To compare the hemodynamic changes to direct laryngoscopy and tracheal intubation between intravenous and nebulized forms of lidocaine. Methods: A prospective, double blind and randomized controlled trial was performed in Kasturba Medical College, Manipal. A total of 66 subjects were randomized equally to IV lidocaine and nebulized lidocaine groups. Data was analyzed using IBM SPSS statistical software. Results: There was no statistically significant difference in mean arterial BP (MAP) across the groups pre induction. Post intubation difference in MAP was noted between the groups at 1, 2, 3, 4 and 5 min. Proportion of subjects with >25% deviation in heart rate was 63.63%, 45.45% and 68.18% whereas subjects with >25% deviation in MAP was 72.73%, 54.55% and 54.55%in IV and Nebulized lignocaine group respectively. Drop in MAP was observed in 9.09%subjects each in nebulization and IV groups. Conclusion: Since no significant differences were observed between IV and nebulized lidocaine groups, clinicians may choose any of the methods, based on the cost and preference, till further evidence is generated.