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

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.