Comparative study between sprayed and inhaled nebulized lidocaine for suppression of hemodynamic response to laryngoscopy and oral endotracheal intubation

Background: Direct laryngoscopic manipulation and endotracheal intubation are noxious stimuli capable of producing hemodynamic changes characterized by tachycardia, hypertension, and arrhythmias. Which are tolerated in normotensive healthy individuals but had greater impact in patients with cardiovascular and cerebrovascular diseases lead to increased morbidity and mortality. Aim of the study: To compare the efficacy of sprayed and inhaled nebulized lidocaine in suppressing the cardiovascular response to laryngoscopy and tracheal intubation in normotensive patients undergoing general anesthesia. Patient and method: 80 adult patients undergoing elective surgery under general anesthesia with endotracheal intubation were randomly allocated into two equal groups. Patients in nebulized lidocaine (NL) group received pre-induction nebulized (1ml of 10%) lidocaine, while those in sprayed lidocaine (SL) group received pre-induction sprayed (10 puffs of 10%) lidocaine. The general anesthesia technique was standardized for the two groups. The primary outcome measures were hemodynamic response at 1, 3, 6, 9, and 12 min after intubation. The secondary outcome measures were to note down any adverse effects associated with drugs. The statistical package used was SPSS version 25.Results: There was a statistically significant difference (P < 0.05) between nebulizes and sprayed lidocaine in heart rate, systolic, diastolic and mean arterial pressures at different time points after tracheal intubation with nebulized lidocaine being most effective and better toleration. Conclusion: The hemodynamic instability was lesser with nebulized lidocaine as compared to sprayed lidocaine. The effect was on heart rate and blood pressure. Use of nebulized lidocaine is simple, safe, effective and better patient acceptance.