Guest guest Posted March 23, 2005 Report Share Posted March 23, 2005 It was thought to, but when studied did not--and also increases the possibility of seizures. It is out. BEB E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: RSI Drugs Dr. Bledsoe, I have always heard of lido being used to decrease intraocular pressure and ICP in head injury patients during RSI attempts. Is this inaccurate now? I am always trying to keep up, and this is a change I was not aware of. Could you elaborate some? Thanks Chris Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted March 23, 2005 It was thought to, but when studied did not--and also increases the possibility of seizures. It is out. BEB E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: RSI Drugs Dr. Bledsoe, I have always heard of lido being used to decrease intraocular pressure and ICP in head injury patients during RSI attempts. Is this inaccurate now? I am always trying to keep up, and this is a change I was not aware of. Could you elaborate some? Thanks Chris Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted March 23, 2005 Dr. Bledsoe, who did these studies and where are these studies you talk about so we may learn? Ron A. Derrick LP NREMT-P Director of Emergency Services City of Fredericksburg ----- Re: RSI Drugs > > >Dr. Bledsoe, > I have always heard of lido being used to decrease intraocular pressure and >ICP in head injury patients during RSI attempts. Is this inaccurate now? I >am always trying to keep up, and this is a change I was not aware of. Could >you elaborate some? > >Thanks >Chris > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted March 23, 2005 Dr. Bledsoe, who did these studies and where are these studies you talk about so we may learn? Ron A. Derrick LP NREMT-P Director of Emergency Services City of Fredericksburg ----- Re: RSI Drugs > > >Dr. Bledsoe, > I have always heard of lido being used to decrease intraocular pressure and >ICP in head injury patients during RSI attempts. Is this inaccurate now? I >am always trying to keep up, and this is a change I was not aware of. Could >you elaborate some? > >Thanks >Chris > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted March 23, 2005 Dr. Bledsoe, who did these studies and where are these studies you talk about so we may learn? Ron A. Derrick LP NREMT-P Director of Emergency Services City of Fredericksburg ----- Re: RSI Drugs > > >Dr. Bledsoe, > I have always heard of lido being used to decrease intraocular pressure and >ICP in head injury patients during RSI attempts. Is this inaccurate now? I >am always trying to keep up, and this is a change I was not aware of. Could >you elaborate some? > >Thanks >Chris > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted March 23, 2005 Emerg Med J. 2001 Nov;18(6):453-7. In patients with head injury undergoing rapid sequence intubation, does pretreatment with intravenous lignocaine/lidocaine lead to an improved neurological outcome? A review of the literature. N, Clancy M. Emergency Department, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. poppabear66@... It is well known that laryngeal instrumentation and endotracheal intubation is associated with a marked, transient rise in intracranial pressure (ICP). Patients with head injury requiring endotracheal intubation are considered particularly at risk from this transient rise in ICP as it reduces cerebral perfusion and thus may increase secondary brain injury. The favoured method for securing a definitive airway in this patient group is by rapid sequence intubation (RSI). In the United States the Emergency Airway Course teaches emergency physicians to routinely administer intravenous lidocaine as a pre treatment for RSI in this patient group in an attempt to attenuate this rise in ICP. A literature search was carried out to identify studies in which intravenous lidocaine was used as a pretreatment for RSI in major head injury. Any link to an improved neurological outcome was also sought. Papers identified were appraised in the manner recommended by the evidence based medicine group to ensure validity. There were no studies identified that answered our question directly and, furthermore, it is our belief that no such study, at present, exists in the literature. Six valid papers were found, which individually contained elements of the question posed and these are presented in a narrative and graphic form. There is currently no evidence to support the use of intravenous lidocaine as a pretreatment for RSI in patients with head injury and its use should only occur in clinical trials. Publication Types: Review Review, Tutorial ____________________________________________________________________________ __- J Trauma. 2005 Feb;58(2):278-83. Intracranial pressure changes during rapid sequence intubation: a swine model. Bozeman WP, Idris AH. Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. wbozeman@... BACKGROUND: Controversy and speculation exist regarding intracranial pressure (ICP) changes produced by various combinations of rapid sequence intubation (RSI) agents. In this pilot study, we sought to develop a swine model to investigate these changes in classic RSI. METHODS: Eight adult swine were instrumented with arterial and intracranial pressure monitors. Four different versions of rapid sequence intubation were then performed sequentially in each animal in a crossover trial design: regimen 1, thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, thiopental, and succinylcholine. ICP and hemodynamic parameters were recorded and compared. Trials were excluded from analysis if baseline ICP measurements were unstable or if intubation was difficult. RESULTS: Peak changes in ICP were noted at 2 to 3 minutes after administration of induction agents. Mean values for peak changes in ICP were as follows: regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm Hg); regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables investigators to examine the aggregate ICP effects of combinations of RSI medications. RSI regimens with paralysis produced threefold increases in peak ICP change compared with the sedation-only regimen. Pretreatment agents did not affect ICP changes. Future investigations can examine other agents and add experimental manipulation of ICP to simulate head injury physiology. Additional parameters including cerebral metabolism and/or oxygenation may also be explored. ____________________________________________________________________________ _______________________________ Lidocaine toxicity. Mehra P, Caiazzo A, Maloney P. Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Massachusetts 02118, USA. Local anesthetics are the most commonly used drugs in dentistry. The number of adverse reactions reported, particularly toxic reactions, are extraordinarily negligible. This article reports a case of lidocaine toxicity with its typical manifestation in a 37-yr-old healthy male. The toxic reaction followed transoral/transpharyngeal topical spraying of lidocaine preoperatively during preparation for general anesthesia. A review of dosages of the most commonly used local anesthetic drugs in dentistry and the management of a toxic reaction is presented. Clinicians need to be in a position to recognize and successfully manage this potential adverse reaction. Publication Types: Case Reports Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted March 23, 2005 Emerg Med J. 2001 Nov;18(6):453-7. In patients with head injury undergoing rapid sequence intubation, does pretreatment with intravenous lignocaine/lidocaine lead to an improved neurological outcome? A review of the literature. N, Clancy M. Emergency Department, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. poppabear66@... It is well known that laryngeal instrumentation and endotracheal intubation is associated with a marked, transient rise in intracranial pressure (ICP). Patients with head injury requiring endotracheal intubation are considered particularly at risk from this transient rise in ICP as it reduces cerebral perfusion and thus may increase secondary brain injury. The favoured method for securing a definitive airway in this patient group is by rapid sequence intubation (RSI). In the United States the Emergency Airway Course teaches emergency physicians to routinely administer intravenous lidocaine as a pre treatment for RSI in this patient group in an attempt to attenuate this rise in ICP. A literature search was carried out to identify studies in which intravenous lidocaine was used as a pretreatment for RSI in major head injury. Any link to an improved neurological outcome was also sought. Papers identified were appraised in the manner recommended by the evidence based medicine group to ensure validity. There were no studies identified that answered our question directly and, furthermore, it is our belief that no such study, at present, exists in the literature. Six valid papers were found, which individually contained elements of the question posed and these are presented in a narrative and graphic form. There is currently no evidence to support the use of intravenous lidocaine as a pretreatment for RSI in patients with head injury and its use should only occur in clinical trials. Publication Types: Review Review, Tutorial ____________________________________________________________________________ __- J Trauma. 2005 Feb;58(2):278-83. Intracranial pressure changes during rapid sequence intubation: a swine model. Bozeman WP, Idris AH. Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. wbozeman@... BACKGROUND: Controversy and speculation exist regarding intracranial pressure (ICP) changes produced by various combinations of rapid sequence intubation (RSI) agents. In this pilot study, we sought to develop a swine model to investigate these changes in classic RSI. METHODS: Eight adult swine were instrumented with arterial and intracranial pressure monitors. Four different versions of rapid sequence intubation were then performed sequentially in each animal in a crossover trial design: regimen 1, thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, thiopental, and succinylcholine. ICP and hemodynamic parameters were recorded and compared. Trials were excluded from analysis if baseline ICP measurements were unstable or if intubation was difficult. RESULTS: Peak changes in ICP were noted at 2 to 3 minutes after administration of induction agents. Mean values for peak changes in ICP were as follows: regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm Hg); regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables investigators to examine the aggregate ICP effects of combinations of RSI medications. RSI regimens with paralysis produced threefold increases in peak ICP change compared with the sedation-only regimen. Pretreatment agents did not affect ICP changes. Future investigations can examine other agents and add experimental manipulation of ICP to simulate head injury physiology. Additional parameters including cerebral metabolism and/or oxygenation may also be explored. ____________________________________________________________________________ _______________________________ Lidocaine toxicity. Mehra P, Caiazzo A, Maloney P. Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Massachusetts 02118, USA. Local anesthetics are the most commonly used drugs in dentistry. The number of adverse reactions reported, particularly toxic reactions, are extraordinarily negligible. This article reports a case of lidocaine toxicity with its typical manifestation in a 37-yr-old healthy male. The toxic reaction followed transoral/transpharyngeal topical spraying of lidocaine preoperatively during preparation for general anesthesia. A review of dosages of the most commonly used local anesthetic drugs in dentistry and the management of a toxic reaction is presented. Clinicians need to be in a position to recognize and successfully manage this potential adverse reaction. Publication Types: Case Reports Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2005 Report Share Posted March 23, 2005 Emerg Med J. 2001 Nov;18(6):453-7. In patients with head injury undergoing rapid sequence intubation, does pretreatment with intravenous lignocaine/lidocaine lead to an improved neurological outcome? A review of the literature. N, Clancy M. Emergency Department, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. poppabear66@... It is well known that laryngeal instrumentation and endotracheal intubation is associated with a marked, transient rise in intracranial pressure (ICP). Patients with head injury requiring endotracheal intubation are considered particularly at risk from this transient rise in ICP as it reduces cerebral perfusion and thus may increase secondary brain injury. The favoured method for securing a definitive airway in this patient group is by rapid sequence intubation (RSI). In the United States the Emergency Airway Course teaches emergency physicians to routinely administer intravenous lidocaine as a pre treatment for RSI in this patient group in an attempt to attenuate this rise in ICP. A literature search was carried out to identify studies in which intravenous lidocaine was used as a pretreatment for RSI in major head injury. Any link to an improved neurological outcome was also sought. Papers identified were appraised in the manner recommended by the evidence based medicine group to ensure validity. There were no studies identified that answered our question directly and, furthermore, it is our belief that no such study, at present, exists in the literature. Six valid papers were found, which individually contained elements of the question posed and these are presented in a narrative and graphic form. There is currently no evidence to support the use of intravenous lidocaine as a pretreatment for RSI in patients with head injury and its use should only occur in clinical trials. Publication Types: Review Review, Tutorial ____________________________________________________________________________ __- J Trauma. 2005 Feb;58(2):278-83. Intracranial pressure changes during rapid sequence intubation: a swine model. Bozeman WP, Idris AH. Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. wbozeman@... BACKGROUND: Controversy and speculation exist regarding intracranial pressure (ICP) changes produced by various combinations of rapid sequence intubation (RSI) agents. In this pilot study, we sought to develop a swine model to investigate these changes in classic RSI. METHODS: Eight adult swine were instrumented with arterial and intracranial pressure monitors. Four different versions of rapid sequence intubation were then performed sequentially in each animal in a crossover trial design: regimen 1, thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, thiopental, and succinylcholine. ICP and hemodynamic parameters were recorded and compared. Trials were excluded from analysis if baseline ICP measurements were unstable or if intubation was difficult. RESULTS: Peak changes in ICP were noted at 2 to 3 minutes after administration of induction agents. Mean values for peak changes in ICP were as follows: regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm Hg); regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables investigators to examine the aggregate ICP effects of combinations of RSI medications. RSI regimens with paralysis produced threefold increases in peak ICP change compared with the sedation-only regimen. Pretreatment agents did not affect ICP changes. Future investigations can examine other agents and add experimental manipulation of ICP to simulate head injury physiology. Additional parameters including cerebral metabolism and/or oxygenation may also be explored. ____________________________________________________________________________ _______________________________ Lidocaine toxicity. Mehra P, Caiazzo A, Maloney P. Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Massachusetts 02118, USA. Local anesthetics are the most commonly used drugs in dentistry. The number of adverse reactions reported, particularly toxic reactions, are extraordinarily negligible. This article reports a case of lidocaine toxicity with its typical manifestation in a 37-yr-old healthy male. The toxic reaction followed transoral/transpharyngeal topical spraying of lidocaine preoperatively during preparation for general anesthesia. A review of dosages of the most commonly used local anesthetic drugs in dentistry and the management of a toxic reaction is presented. Clinicians need to be in a position to recognize and successfully manage this potential adverse reaction. Publication Types: Case Reports Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2005 Report Share Posted March 24, 2005 I've intubated a few swine in my day also. Most were riding Harleys as I recall, so I naturally assumed low ICP to begin with. Gene > > Emerg Med J. 2001 Nov;18(6):453-7. > Â > In patients with head injury undergoing rapid sequence intubation, does > pretreatment with intravenous lignocaine/lidocaine lead to an improved > neurological outcome? A review of the literature. > > N, Clancy M. > > Emergency Department, Southampton General Hospital, Tremona Road, > Southampton SO16 6YD, UK. poppabear66@... > > It is well known that laryngeal instrumentation and endotracheal intubation > is associated with a marked, transient rise in intracranial pressure (ICP). > Patients with head injury requiring endotracheal intubation are considered > particularly at risk from this transient rise in ICP as it reduces cerebral > perfusion and thus may increase secondary brain injury. The favoured method > for securing a definitive airway in this patient group is by rapid sequence > intubation (RSI). In the United States the Emergency Airway Course teaches > emergency physicians to routinely administer intravenous lidocaine as a pre > treatment for RSI in this patient group in an attempt to attenuate this rise > in ICP. A literature search was carried out to identify studies in which > intravenous lidocaine was used as a pretreatment for RSI in major head > injury. Any link to an improved neurological outcome was also sought. Papers > identified were appraised in the manner recommended by the evidence based > medicine group to ensure validity. There were no studies identified that > answered our question directly and, furthermore, it is our belief that no > such study, at present, exists in the literature. Six valid papers were > found, which individually contained elements of the question posed and these > are presented in a narrative and graphic form. There is currently no > evidence to support the use of intravenous lidocaine as a pretreatment for > RSI in patients with head injury and its use should only occur in clinical > trials. > > Publication Types: > Review > Review, Tutorial > > ____________________________________________________________________________ > __- > J Trauma. 2005 Feb;58(2):278-83. > > Â > Intracranial pressure changes during rapid sequence intubation: a swine > model. > > Bozeman WP, Idris AH. > > Department of Emergency Medicine, Wake Forest University School of Medicine, > Winston-Salem, NC 27157, USA. wbozeman@... > > BACKGROUND: Controversy and speculation exist regarding intracranial > pressure (ICP) changes produced by various combinations of rapid sequence > intubation (RSI) agents. In this pilot study, we sought to develop a swine > model to investigate these changes in classic RSI. METHODS: Eight adult > swine were instrumented with arterial and intracranial pressure monitors. > Four different versions of rapid sequence intubation were then performed > sequentially in each animal in a crossover trial design: regimen 1, > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > thiopental, and succinylcholine. ICP and hemodynamic parameters were > recorded and compared. Trials were excluded from analysis if baseline ICP > measurements were unstable or if intubation was difficult. RESULTS: Peak > changes in ICP were noted at 2 to 3 minutes after administration of > induction agents. Mean values for peak changes in ICP were as follows: > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm Hg); > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > investigators to examine the aggregate ICP effects of combinations of RSI > medications. RSI regimens with paralysis produced threefold increases in > peak ICP change compared with the sedation-only regimen. Pretreatment agents > did not affect ICP changes. Future investigations can examine other agents > and add experimental manipulation of ICP to simulate head injury physiology. > Additional parameters including cerebral metabolism and/or oxygenation may > also be explored. > > ____________________________________________________________________________ > _______________________________ > Lidocaine toxicity. > > Mehra P, Caiazzo A, Maloney P. > > Department of Oral and Maxillofacial Surgery, Boston University School of > Dental Medicine, Massachusetts 02118, USA. > > Local anesthetics are the most commonly used drugs in dentistry. The number > of adverse reactions reported, particularly toxic reactions, are > extraordinarily negligible. This article reports a case of lidocaine > toxicity with its typical manifestation in a 37-yr-old healthy male. The > toxic reaction followed transoral/transpharyngeal topical spraying of > lidocaine preoperatively during preparation for general anesthesia. A review > of dosages of the most commonly used local anesthetic drugs in dentistry and > the management of a toxic reaction is presented. Clinicians need to be in a > position to recognize and successfully manage this potential adverse > reaction. > > Publication Types: > Case Reports > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2005 Report Share Posted March 24, 2005 I've intubated a few swine in my day also. Most were riding Harleys as I recall, so I naturally assumed low ICP to begin with. Gene > > Emerg Med J. 2001 Nov;18(6):453-7. > Â > In patients with head injury undergoing rapid sequence intubation, does > pretreatment with intravenous lignocaine/lidocaine lead to an improved > neurological outcome? A review of the literature. > > N, Clancy M. > > Emergency Department, Southampton General Hospital, Tremona Road, > Southampton SO16 6YD, UK. poppabear66@... > > It is well known that laryngeal instrumentation and endotracheal intubation > is associated with a marked, transient rise in intracranial pressure (ICP). > Patients with head injury requiring endotracheal intubation are considered > particularly at risk from this transient rise in ICP as it reduces cerebral > perfusion and thus may increase secondary brain injury. The favoured method > for securing a definitive airway in this patient group is by rapid sequence > intubation (RSI). In the United States the Emergency Airway Course teaches > emergency physicians to routinely administer intravenous lidocaine as a pre > treatment for RSI in this patient group in an attempt to attenuate this rise > in ICP. A literature search was carried out to identify studies in which > intravenous lidocaine was used as a pretreatment for RSI in major head > injury. Any link to an improved neurological outcome was also sought. Papers > identified were appraised in the manner recommended by the evidence based > medicine group to ensure validity. There were no studies identified that > answered our question directly and, furthermore, it is our belief that no > such study, at present, exists in the literature. Six valid papers were > found, which individually contained elements of the question posed and these > are presented in a narrative and graphic form. There is currently no > evidence to support the use of intravenous lidocaine as a pretreatment for > RSI in patients with head injury and its use should only occur in clinical > trials. > > Publication Types: > Review > Review, Tutorial > > ____________________________________________________________________________ > __- > J Trauma. 2005 Feb;58(2):278-83. > > Â > Intracranial pressure changes during rapid sequence intubation: a swine > model. > > Bozeman WP, Idris AH. > > Department of Emergency Medicine, Wake Forest University School of Medicine, > Winston-Salem, NC 27157, USA. wbozeman@... > > BACKGROUND: Controversy and speculation exist regarding intracranial > pressure (ICP) changes produced by various combinations of rapid sequence > intubation (RSI) agents. In this pilot study, we sought to develop a swine > model to investigate these changes in classic RSI. METHODS: Eight adult > swine were instrumented with arterial and intracranial pressure monitors. > Four different versions of rapid sequence intubation were then performed > sequentially in each animal in a crossover trial design: regimen 1, > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > thiopental, and succinylcholine. ICP and hemodynamic parameters were > recorded and compared. Trials were excluded from analysis if baseline ICP > measurements were unstable or if intubation was difficult. RESULTS: Peak > changes in ICP were noted at 2 to 3 minutes after administration of > induction agents. Mean values for peak changes in ICP were as follows: > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm Hg); > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > investigators to examine the aggregate ICP effects of combinations of RSI > medications. RSI regimens with paralysis produced threefold increases in > peak ICP change compared with the sedation-only regimen. Pretreatment agents > did not affect ICP changes. Future investigations can examine other agents > and add experimental manipulation of ICP to simulate head injury physiology. > Additional parameters including cerebral metabolism and/or oxygenation may > also be explored. > > ____________________________________________________________________________ > _______________________________ > Lidocaine toxicity. > > Mehra P, Caiazzo A, Maloney P. > > Department of Oral and Maxillofacial Surgery, Boston University School of > Dental Medicine, Massachusetts 02118, USA. > > Local anesthetics are the most commonly used drugs in dentistry. The number > of adverse reactions reported, particularly toxic reactions, are > extraordinarily negligible. This article reports a case of lidocaine > toxicity with its typical manifestation in a 37-yr-old healthy male. The > toxic reaction followed transoral/transpharyngeal topical spraying of > lidocaine preoperatively during preparation for general anesthesia. A review > of dosages of the most commonly used local anesthetic drugs in dentistry and > the management of a toxic reaction is presented. Clinicians need to be in a > position to recognize and successfully manage this potential adverse > reaction. > > Publication Types: > Case Reports > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2005 Report Share Posted March 24, 2005 I've intubated a few swine in my day also. Most were riding Harleys as I recall, so I naturally assumed low ICP to begin with. Gene > > Emerg Med J. 2001 Nov;18(6):453-7. > Â > In patients with head injury undergoing rapid sequence intubation, does > pretreatment with intravenous lignocaine/lidocaine lead to an improved > neurological outcome? A review of the literature. > > N, Clancy M. > > Emergency Department, Southampton General Hospital, Tremona Road, > Southampton SO16 6YD, UK. poppabear66@... > > It is well known that laryngeal instrumentation and endotracheal intubation > is associated with a marked, transient rise in intracranial pressure (ICP). > Patients with head injury requiring endotracheal intubation are considered > particularly at risk from this transient rise in ICP as it reduces cerebral > perfusion and thus may increase secondary brain injury. The favoured method > for securing a definitive airway in this patient group is by rapid sequence > intubation (RSI). In the United States the Emergency Airway Course teaches > emergency physicians to routinely administer intravenous lidocaine as a pre > treatment for RSI in this patient group in an attempt to attenuate this rise > in ICP. A literature search was carried out to identify studies in which > intravenous lidocaine was used as a pretreatment for RSI in major head > injury. Any link to an improved neurological outcome was also sought. Papers > identified were appraised in the manner recommended by the evidence based > medicine group to ensure validity. There were no studies identified that > answered our question directly and, furthermore, it is our belief that no > such study, at present, exists in the literature. Six valid papers were > found, which individually contained elements of the question posed and these > are presented in a narrative and graphic form. There is currently no > evidence to support the use of intravenous lidocaine as a pretreatment for > RSI in patients with head injury and its use should only occur in clinical > trials. > > Publication Types: > Review > Review, Tutorial > > ____________________________________________________________________________ > __- > J Trauma. 2005 Feb;58(2):278-83. > > Â > Intracranial pressure changes during rapid sequence intubation: a swine > model. > > Bozeman WP, Idris AH. > > Department of Emergency Medicine, Wake Forest University School of Medicine, > Winston-Salem, NC 27157, USA. wbozeman@... > > BACKGROUND: Controversy and speculation exist regarding intracranial > pressure (ICP) changes produced by various combinations of rapid sequence > intubation (RSI) agents. In this pilot study, we sought to develop a swine > model to investigate these changes in classic RSI. METHODS: Eight adult > swine were instrumented with arterial and intracranial pressure monitors. > Four different versions of rapid sequence intubation were then performed > sequentially in each animal in a crossover trial design: regimen 1, > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > thiopental, and succinylcholine. ICP and hemodynamic parameters were > recorded and compared. Trials were excluded from analysis if baseline ICP > measurements were unstable or if intubation was difficult. RESULTS: Peak > changes in ICP were noted at 2 to 3 minutes after administration of > induction agents. Mean values for peak changes in ICP were as follows: > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm Hg); > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > investigators to examine the aggregate ICP effects of combinations of RSI > medications. RSI regimens with paralysis produced threefold increases in > peak ICP change compared with the sedation-only regimen. Pretreatment agents > did not affect ICP changes. Future investigations can examine other agents > and add experimental manipulation of ICP to simulate head injury physiology. > Additional parameters including cerebral metabolism and/or oxygenation may > also be explored. > > ____________________________________________________________________________ > _______________________________ > Lidocaine toxicity. > > Mehra P, Caiazzo A, Maloney P. > > Department of Oral and Maxillofacial Surgery, Boston University School of > Dental Medicine, Massachusetts 02118, USA. > > Local anesthetics are the most commonly used drugs in dentistry. The number > of adverse reactions reported, particularly toxic reactions, are > extraordinarily negligible. This article reports a case of lidocaine > toxicity with its typical manifestation in a 37-yr-old healthy male. The > toxic reaction followed transoral/transpharyngeal topical spraying of > lidocaine preoperatively during preparation for general anesthesia. A review > of dosages of the most commonly used local anesthetic drugs in dentistry and > the management of a toxic reaction is presented. Clinicians need to be in a > position to recognize and successfully manage this potential adverse > reaction. > > Publication Types: > Case Reports > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2005 Report Share Posted March 24, 2005 What a sad assumption you make, Gene. Re: RSI Drugs I've intubated a few swine in my day also. Most were riding Harleys as I recall, so I naturally assumed low ICP to begin with. Gene > > Emerg Med J. 2001 Nov;18(6):453-7. > Â > In patients with head injury undergoing rapid sequence intubation, does > pretreatment with intravenous lignocaine/lidocaine lead to an improved > neurological outcome? A review of the literature. > > N, Clancy M. > > Emergency Department, Southampton General Hospital, Tremona Road, > Southampton SO16 6YD, UK. poppabear66@... > > It is well known that laryngeal instrumentation and endotracheal intubation > is associated with a marked, transient rise in intracranial pressure (ICP). > Patients with head injury requiring endotracheal intubation are considered > particularly at risk from this transient rise in ICP as it reduces cerebral > perfusion and thus may increase secondary brain injury. The favoured method > for securing a definitive airway in this patient group is by rapid sequence > intubation (RSI). In the United States the Emergency Airway Course teaches > emergency physicians to routinely administer intravenous lidocaine as a pre > treatment for RSI in this patient group in an attempt to attenuate this rise > in ICP. A literature search was carried out to identify studies in which > intravenous lidocaine was used as a pretreatment for RSI in major head > injury. Any link to an improved neurological outcome was also sought. Papers > identified were appraised in the manner recommended by the evidence based > medicine group to ensure validity. There were no studies identified that > answered our question directly and, furthermore, it is our belief that no > such study, at present, exists in the literature. Six valid papers were > found, which individually contained elements of the question posed and these > are presented in a narrative and graphic form. There is currently no > evidence to support the use of intravenous lidocaine as a pretreatment for > RSI in patients with head injury and its use should only occur in clinical > trials. > > Publication Types: > Review > Review, Tutorial > > ____________________________________________________________________________ > __- > J Trauma. 2005 Feb;58(2):278-83. > > Â > Intracranial pressure changes during rapid sequence intubation: a swine > model. > > Bozeman WP, Idris AH. > > Department of Emergency Medicine, Wake Forest University School of Medicine, > Winston-Salem, NC 27157, USA. wbozeman@... > > BACKGROUND: Controversy and speculation exist regarding intracranial > pressure (ICP) changes produced by various combinations of rapid sequence > intubation (RSI) agents. In this pilot study, we sought to develop a swine > model to investigate these changes in classic RSI. METHODS: Eight adult > swine were instrumented with arterial and intracranial pressure monitors. > Four different versions of rapid sequence intubation were then performed > sequentially in each animal in a crossover trial design: regimen 1, > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > thiopental, and succinylcholine. ICP and hemodynamic parameters were > recorded and compared. Trials were excluded from analysis if baseline ICP > measurements were unstable or if intubation was difficult. RESULTS: Peak > changes in ICP were noted at 2 to 3 minutes after administration of > induction agents. Mean values for peak changes in ICP were as follows: > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm Hg); > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > investigators to examine the aggregate ICP effects of combinations of RSI > medications. RSI regimens with paralysis produced threefold increases in > peak ICP change compared with the sedation-only regimen. Pretreatment agents > did not affect ICP changes. Future investigations can examine other agents > and add experimental manipulation of ICP to simulate head injury physiology. > Additional parameters including cerebral metabolism and/or oxygenation may > also be explored. > > ____________________________________________________________________________ > _______________________________ > Lidocaine toxicity. > > Mehra P, Caiazzo A, Maloney P. > > Department of Oral and Maxillofacial Surgery, Boston University School of > Dental Medicine, Massachusetts 02118, USA. > > Local anesthetics are the most commonly used drugs in dentistry. The number > of adverse reactions reported, particularly toxic reactions, are > extraordinarily negligible. This article reports a case of lidocaine > toxicity with its typical manifestation in a 37-yr-old healthy male. The > toxic reaction followed transoral/transpharyngeal topical spraying of > lidocaine preoperatively during preparation for general anesthesia. A review > of dosages of the most commonly used local anesthetic drugs in dentistry and > the management of a toxic reaction is presented. Clinicians need to be in a > position to recognize and successfully manage this potential adverse > reaction. > > Publication Types: > Case Reports > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2005 Report Share Posted March 24, 2005 What a sad assumption you make, Gene. Re: RSI Drugs I've intubated a few swine in my day also. Most were riding Harleys as I recall, so I naturally assumed low ICP to begin with. Gene > > Emerg Med J. 2001 Nov;18(6):453-7. > Â > In patients with head injury undergoing rapid sequence intubation, does > pretreatment with intravenous lignocaine/lidocaine lead to an improved > neurological outcome? A review of the literature. > > N, Clancy M. > > Emergency Department, Southampton General Hospital, Tremona Road, > Southampton SO16 6YD, UK. poppabear66@... > > It is well known that laryngeal instrumentation and endotracheal intubation > is associated with a marked, transient rise in intracranial pressure (ICP). > Patients with head injury requiring endotracheal intubation are considered > particularly at risk from this transient rise in ICP as it reduces cerebral > perfusion and thus may increase secondary brain injury. The favoured method > for securing a definitive airway in this patient group is by rapid sequence > intubation (RSI). In the United States the Emergency Airway Course teaches > emergency physicians to routinely administer intravenous lidocaine as a pre > treatment for RSI in this patient group in an attempt to attenuate this rise > in ICP. A literature search was carried out to identify studies in which > intravenous lidocaine was used as a pretreatment for RSI in major head > injury. Any link to an improved neurological outcome was also sought. Papers > identified were appraised in the manner recommended by the evidence based > medicine group to ensure validity. There were no studies identified that > answered our question directly and, furthermore, it is our belief that no > such study, at present, exists in the literature. Six valid papers were > found, which individually contained elements of the question posed and these > are presented in a narrative and graphic form. There is currently no > evidence to support the use of intravenous lidocaine as a pretreatment for > RSI in patients with head injury and its use should only occur in clinical > trials. > > Publication Types: > Review > Review, Tutorial > > ____________________________________________________________________________ > __- > J Trauma. 2005 Feb;58(2):278-83. > > Â > Intracranial pressure changes during rapid sequence intubation: a swine > model. > > Bozeman WP, Idris AH. > > Department of Emergency Medicine, Wake Forest University School of Medicine, > Winston-Salem, NC 27157, USA. wbozeman@... > > BACKGROUND: Controversy and speculation exist regarding intracranial > pressure (ICP) changes produced by various combinations of rapid sequence > intubation (RSI) agents. In this pilot study, we sought to develop a swine > model to investigate these changes in classic RSI. METHODS: Eight adult > swine were instrumented with arterial and intracranial pressure monitors. > Four different versions of rapid sequence intubation were then performed > sequentially in each animal in a crossover trial design: regimen 1, > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > thiopental, and succinylcholine. ICP and hemodynamic parameters were > recorded and compared. Trials were excluded from analysis if baseline ICP > measurements were unstable or if intubation was difficult. RESULTS: Peak > changes in ICP were noted at 2 to 3 minutes after administration of > induction agents. Mean values for peak changes in ICP were as follows: > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm Hg); > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > investigators to examine the aggregate ICP effects of combinations of RSI > medications. RSI regimens with paralysis produced threefold increases in > peak ICP change compared with the sedation-only regimen. Pretreatment agents > did not affect ICP changes. Future investigations can examine other agents > and add experimental manipulation of ICP to simulate head injury physiology. > Additional parameters including cerebral metabolism and/or oxygenation may > also be explored. > > ____________________________________________________________________________ > _______________________________ > Lidocaine toxicity. > > Mehra P, Caiazzo A, Maloney P. > > Department of Oral and Maxillofacial Surgery, Boston University School of > Dental Medicine, Massachusetts 02118, USA. > > Local anesthetics are the most commonly used drugs in dentistry. The number > of adverse reactions reported, particularly toxic reactions, are > extraordinarily negligible. This article reports a case of lidocaine > toxicity with its typical manifestation in a 37-yr-old healthy male. The > toxic reaction followed transoral/transpharyngeal topical spraying of > lidocaine preoperatively during preparation for general anesthesia. A review > of dosages of the most commonly used local anesthetic drugs in dentistry and > the management of a toxic reaction is presented. Clinicians need to be in a > position to recognize and successfully manage this potential adverse > reaction. > > Publication Types: > Case Reports > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2005 Report Share Posted March 24, 2005 What a sad assumption you make, Gene. Re: RSI Drugs I've intubated a few swine in my day also. Most were riding Harleys as I recall, so I naturally assumed low ICP to begin with. Gene > > Emerg Med J. 2001 Nov;18(6):453-7. > Â > In patients with head injury undergoing rapid sequence intubation, does > pretreatment with intravenous lignocaine/lidocaine lead to an improved > neurological outcome? A review of the literature. > > N, Clancy M. > > Emergency Department, Southampton General Hospital, Tremona Road, > Southampton SO16 6YD, UK. poppabear66@... > > It is well known that laryngeal instrumentation and endotracheal intubation > is associated with a marked, transient rise in intracranial pressure (ICP). > Patients with head injury requiring endotracheal intubation are considered > particularly at risk from this transient rise in ICP as it reduces cerebral > perfusion and thus may increase secondary brain injury. The favoured method > for securing a definitive airway in this patient group is by rapid sequence > intubation (RSI). In the United States the Emergency Airway Course teaches > emergency physicians to routinely administer intravenous lidocaine as a pre > treatment for RSI in this patient group in an attempt to attenuate this rise > in ICP. A literature search was carried out to identify studies in which > intravenous lidocaine was used as a pretreatment for RSI in major head > injury. Any link to an improved neurological outcome was also sought. Papers > identified were appraised in the manner recommended by the evidence based > medicine group to ensure validity. There were no studies identified that > answered our question directly and, furthermore, it is our belief that no > such study, at present, exists in the literature. Six valid papers were > found, which individually contained elements of the question posed and these > are presented in a narrative and graphic form. There is currently no > evidence to support the use of intravenous lidocaine as a pretreatment for > RSI in patients with head injury and its use should only occur in clinical > trials. > > Publication Types: > Review > Review, Tutorial > > ____________________________________________________________________________ > __- > J Trauma. 2005 Feb;58(2):278-83. > > Â > Intracranial pressure changes during rapid sequence intubation: a swine > model. > > Bozeman WP, Idris AH. > > Department of Emergency Medicine, Wake Forest University School of Medicine, > Winston-Salem, NC 27157, USA. wbozeman@... > > BACKGROUND: Controversy and speculation exist regarding intracranial > pressure (ICP) changes produced by various combinations of rapid sequence > intubation (RSI) agents. In this pilot study, we sought to develop a swine > model to investigate these changes in classic RSI. METHODS: Eight adult > swine were instrumented with arterial and intracranial pressure monitors. > Four different versions of rapid sequence intubation were then performed > sequentially in each animal in a crossover trial design: regimen 1, > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > thiopental, and succinylcholine. ICP and hemodynamic parameters were > recorded and compared. Trials were excluded from analysis if baseline ICP > measurements were unstable or if intubation was difficult. RESULTS: Peak > changes in ICP were noted at 2 to 3 minutes after administration of > induction agents. Mean values for peak changes in ICP were as follows: > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm Hg); > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > investigators to examine the aggregate ICP effects of combinations of RSI > medications. RSI regimens with paralysis produced threefold increases in > peak ICP change compared with the sedation-only regimen. Pretreatment agents > did not affect ICP changes. Future investigations can examine other agents > and add experimental manipulation of ICP to simulate head injury physiology. > Additional parameters including cerebral metabolism and/or oxygenation may > also be explored. > > ____________________________________________________________________________ > _______________________________ > Lidocaine toxicity. > > Mehra P, Caiazzo A, Maloney P. > > Department of Oral and Maxillofacial Surgery, Boston University School of > Dental Medicine, Massachusetts 02118, USA. > > Local anesthetics are the most commonly used drugs in dentistry. The number > of adverse reactions reported, particularly toxic reactions, are > extraordinarily negligible. This article reports a case of lidocaine > toxicity with its typical manifestation in a 37-yr-old healthy male. The > toxic reaction followed transoral/transpharyngeal topical spraying of > lidocaine preoperatively during preparation for general anesthesia. A review > of dosages of the most commonly used local anesthetic drugs in dentistry and > the management of a toxic reaction is presented. Clinicians need to be in a > position to recognize and successfully manage this potential adverse > reaction. > > Publication Types: > Case Reports > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2005 Report Share Posted March 24, 2005 Gene, Hey now, I resemble that remark!!!! And if the swine you refer had also been a lawyer... Their heads are so swollen with hot air and methane, likely no further damage occurred in impact. (production of methane gas from organic waste, primarily manure, which is easily accomplished) bkw Re: RSI Drugs I've intubated a few swine in my day also. Most were riding Harleys as I recall, so I naturally assumed low ICP to begin with. Gene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2005 Report Share Posted March 24, 2005 Rather judgmental statement don't you think Gene? Barry Meffert In a message dated 3/24/2005 2:24:25 PM Central Standard Time, wegandy1938@... writes: I've intubated a few swine in my day also. Most were riding Harleys as I recall, so I naturally assumed low ICP to begin with. Gene > > Emerg Med J. 2001 Nov;18(6):453-7. > > In patients with head injury undergoing rapid sequence intubation, does > pretreatment with intravenous lignocaine/lidocaine lead to an improved > neurological outcome? A review of the literature. > > N, Clancy M. > > Emergency Department, Southampton General Hospital, Tremona Road, > Southampton SO16 6YD, UK. poppabear66@... > > It is well known that laryngeal instrumentation and endotracheal intubation > is associated with a marked, transient rise in intracranial pressure (ICP). > Patients with head injury requiring endotracheal intubation are considered > particularly at risk from this transient rise in ICP as it reduces cerebral > perfusion and thus may increase secondary brain injury. The favoured method > for securing a definitive airway in this patient group is by rapid sequence > intubation (RSI). In the United States the Emergency Airway Course teaches > emergency physicians to routinely administer intravenous lidocaine as a pre > treatment for RSI in this patient group in an attempt to attenuate this rise > in ICP. A literature search was carried out to identify studies in which > intravenous lidocaine was used as a pretreatment for RSI in major head > injury. Any link to an improved neurological outcome was also sought. Papers > identified were appraised in the manner recommended by the evidence based > medicine group to ensure validity. There were no studies identified that > answered our question directly and, furthermore, it is our belief that no > such study, at present, exists in the literature. Six valid papers were > found, which individually contained elements of the question posed and these > are presented in a narrative and graphic form. There is currently no > evidence to support the use of intravenous lidocaine as a pretreatment for > RSI in patients with head injury and its use should only occur in clinical > trials. > > Publication Types: > Review > Review, Tutorial > > ____________________________________________________________________________ > __- > J Trauma. 2005 Feb;58(2):278-83. > > > Intracranial pressure changes during rapid sequence intubation: a swine > model. > > Bozeman WP, Idris AH. > > Department of Emergency Medicine, Wake Forest University School of Medicine, > Winston-Salem, NC 27157, USA. wbozeman@... > > BACKGROUND: Controversy and speculation exist regarding intracranial > pressure (ICP) changes produced by various combinations of rapid sequence > intubation (RSI) agents. In this pilot study, we sought to develop a swine > model to investigate these changes in classic RSI. METHODS: Eight adult > swine were instrumented with arterial and intracranial pressure monitors. > Four different versions of rapid sequence intubation were then performed > sequentially in each animal in a crossover trial design: regimen 1, > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > thiopental, and succinylcholine. ICP and hemodynamic parameters were > recorded and compared. Trials were excluded from analysis if baseline ICP > measurements were unstable or if intubation was difficult. RESULTS: Peak > changes in ICP were noted at 2 to 3 minutes after administration of > induction agents. Mean values for peak changes in ICP were as follows: > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm Hg); > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > investigators to examine the aggregate ICP effects of combinations of RSI > medications. RSI regimens with paralysis produced threefold increases in > peak ICP change compared with the sedation-only regimen. Pretreatment agents > did not affect ICP changes. Future investigations can examine other agents > and add experimental manipulation of ICP to simulate head injury physiology. > Additional parameters including cerebral metabolism and/or oxygenation may > also be explored. > > ____________________________________________________________________________ > _______________________________ > Lidocaine toxicity. > > Mehra P, Caiazzo A, Maloney P. > > Department of Oral and Maxillofacial Surgery, Boston University School of > Dental Medicine, Massachusetts 02118, USA. > > Local anesthetics are the most commonly used drugs in dentistry. The number > of adverse reactions reported, particularly toxic reactions, are > extraordinarily negligible. This article reports a case of lidocaine > toxicity with its typical manifestation in a 37-yr-old healthy male. The > toxic reaction followed transoral/transpharyngeal topical spraying of > lidocaine preoperatively during preparation for general anesthesia. A review > of dosages of the most commonly used local anesthetic drugs in dentistry and > the management of a toxic reaction is presented. Clinicians need to be in a > position to recognize and successfully manage this potential adverse > reaction. > > Publication Types: > Case Reports > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2005 Report Share Posted March 24, 2005 Rather judgmental statement don't you think Gene? Barry Meffert In a message dated 3/24/2005 2:24:25 PM Central Standard Time, wegandy1938@... writes: I've intubated a few swine in my day also. Most were riding Harleys as I recall, so I naturally assumed low ICP to begin with. Gene > > Emerg Med J. 2001 Nov;18(6):453-7. > > In patients with head injury undergoing rapid sequence intubation, does > pretreatment with intravenous lignocaine/lidocaine lead to an improved > neurological outcome? A review of the literature. > > N, Clancy M. > > Emergency Department, Southampton General Hospital, Tremona Road, > Southampton SO16 6YD, UK. poppabear66@... > > It is well known that laryngeal instrumentation and endotracheal intubation > is associated with a marked, transient rise in intracranial pressure (ICP). > Patients with head injury requiring endotracheal intubation are considered > particularly at risk from this transient rise in ICP as it reduces cerebral > perfusion and thus may increase secondary brain injury. The favoured method > for securing a definitive airway in this patient group is by rapid sequence > intubation (RSI). In the United States the Emergency Airway Course teaches > emergency physicians to routinely administer intravenous lidocaine as a pre > treatment for RSI in this patient group in an attempt to attenuate this rise > in ICP. A literature search was carried out to identify studies in which > intravenous lidocaine was used as a pretreatment for RSI in major head > injury. Any link to an improved neurological outcome was also sought. Papers > identified were appraised in the manner recommended by the evidence based > medicine group to ensure validity. There were no studies identified that > answered our question directly and, furthermore, it is our belief that no > such study, at present, exists in the literature. Six valid papers were > found, which individually contained elements of the question posed and these > are presented in a narrative and graphic form. There is currently no > evidence to support the use of intravenous lidocaine as a pretreatment for > RSI in patients with head injury and its use should only occur in clinical > trials. > > Publication Types: > Review > Review, Tutorial > > ____________________________________________________________________________ > __- > J Trauma. 2005 Feb;58(2):278-83. > > > Intracranial pressure changes during rapid sequence intubation: a swine > model. > > Bozeman WP, Idris AH. > > Department of Emergency Medicine, Wake Forest University School of Medicine, > Winston-Salem, NC 27157, USA. wbozeman@... > > BACKGROUND: Controversy and speculation exist regarding intracranial > pressure (ICP) changes produced by various combinations of rapid sequence > intubation (RSI) agents. In this pilot study, we sought to develop a swine > model to investigate these changes in classic RSI. METHODS: Eight adult > swine were instrumented with arterial and intracranial pressure monitors. > Four different versions of rapid sequence intubation were then performed > sequentially in each animal in a crossover trial design: regimen 1, > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > thiopental, and succinylcholine. ICP and hemodynamic parameters were > recorded and compared. Trials were excluded from analysis if baseline ICP > measurements were unstable or if intubation was difficult. RESULTS: Peak > changes in ICP were noted at 2 to 3 minutes after administration of > induction agents. Mean values for peak changes in ICP were as follows: > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm Hg); > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > investigators to examine the aggregate ICP effects of combinations of RSI > medications. RSI regimens with paralysis produced threefold increases in > peak ICP change compared with the sedation-only regimen. Pretreatment agents > did not affect ICP changes. Future investigations can examine other agents > and add experimental manipulation of ICP to simulate head injury physiology. > Additional parameters including cerebral metabolism and/or oxygenation may > also be explored. > > ____________________________________________________________________________ > _______________________________ > Lidocaine toxicity. > > Mehra P, Caiazzo A, Maloney P. > > Department of Oral and Maxillofacial Surgery, Boston University School of > Dental Medicine, Massachusetts 02118, USA. > > Local anesthetics are the most commonly used drugs in dentistry. The number > of adverse reactions reported, particularly toxic reactions, are > extraordinarily negligible. This article reports a case of lidocaine > toxicity with its typical manifestation in a 37-yr-old healthy male. The > toxic reaction followed transoral/transpharyngeal topical spraying of > lidocaine preoperatively during preparation for general anesthesia. A review > of dosages of the most commonly used local anesthetic drugs in dentistry and > the management of a toxic reaction is presented. Clinicians need to be in a > position to recognize and successfully manage this potential adverse > reaction. > > Publication Types: > Case Reports > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2005 Report Share Posted March 24, 2005 Rather judgmental statement don't you think Gene? Barry Meffert In a message dated 3/24/2005 2:24:25 PM Central Standard Time, wegandy1938@... writes: I've intubated a few swine in my day also. Most were riding Harleys as I recall, so I naturally assumed low ICP to begin with. Gene > > Emerg Med J. 2001 Nov;18(6):453-7. > > In patients with head injury undergoing rapid sequence intubation, does > pretreatment with intravenous lignocaine/lidocaine lead to an improved > neurological outcome? A review of the literature. > > N, Clancy M. > > Emergency Department, Southampton General Hospital, Tremona Road, > Southampton SO16 6YD, UK. poppabear66@... > > It is well known that laryngeal instrumentation and endotracheal intubation > is associated with a marked, transient rise in intracranial pressure (ICP). > Patients with head injury requiring endotracheal intubation are considered > particularly at risk from this transient rise in ICP as it reduces cerebral > perfusion and thus may increase secondary brain injury. The favoured method > for securing a definitive airway in this patient group is by rapid sequence > intubation (RSI). In the United States the Emergency Airway Course teaches > emergency physicians to routinely administer intravenous lidocaine as a pre > treatment for RSI in this patient group in an attempt to attenuate this rise > in ICP. A literature search was carried out to identify studies in which > intravenous lidocaine was used as a pretreatment for RSI in major head > injury. Any link to an improved neurological outcome was also sought. Papers > identified were appraised in the manner recommended by the evidence based > medicine group to ensure validity. There were no studies identified that > answered our question directly and, furthermore, it is our belief that no > such study, at present, exists in the literature. Six valid papers were > found, which individually contained elements of the question posed and these > are presented in a narrative and graphic form. There is currently no > evidence to support the use of intravenous lidocaine as a pretreatment for > RSI in patients with head injury and its use should only occur in clinical > trials. > > Publication Types: > Review > Review, Tutorial > > ____________________________________________________________________________ > __- > J Trauma. 2005 Feb;58(2):278-83. > > > Intracranial pressure changes during rapid sequence intubation: a swine > model. > > Bozeman WP, Idris AH. > > Department of Emergency Medicine, Wake Forest University School of Medicine, > Winston-Salem, NC 27157, USA. wbozeman@... > > BACKGROUND: Controversy and speculation exist regarding intracranial > pressure (ICP) changes produced by various combinations of rapid sequence > intubation (RSI) agents. In this pilot study, we sought to develop a swine > model to investigate these changes in classic RSI. METHODS: Eight adult > swine were instrumented with arterial and intracranial pressure monitors. > Four different versions of rapid sequence intubation were then performed > sequentially in each animal in a crossover trial design: regimen 1, > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > thiopental, and succinylcholine. ICP and hemodynamic parameters were > recorded and compared. Trials were excluded from analysis if baseline ICP > measurements were unstable or if intubation was difficult. RESULTS: Peak > changes in ICP were noted at 2 to 3 minutes after administration of > induction agents. Mean values for peak changes in ICP were as follows: > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm Hg); > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > investigators to examine the aggregate ICP effects of combinations of RSI > medications. RSI regimens with paralysis produced threefold increases in > peak ICP change compared with the sedation-only regimen. Pretreatment agents > did not affect ICP changes. Future investigations can examine other agents > and add experimental manipulation of ICP to simulate head injury physiology. > Additional parameters including cerebral metabolism and/or oxygenation may > also be explored. > > ____________________________________________________________________________ > _______________________________ > Lidocaine toxicity. > > Mehra P, Caiazzo A, Maloney P. > > Department of Oral and Maxillofacial Surgery, Boston University School of > Dental Medicine, Massachusetts 02118, USA. > > Local anesthetics are the most commonly used drugs in dentistry. The number > of adverse reactions reported, particularly toxic reactions, are > extraordinarily negligible. This article reports a case of lidocaine > toxicity with its typical manifestation in a 37-yr-old healthy male. The > toxic reaction followed transoral/transpharyngeal topical spraying of > lidocaine preoperatively during preparation for general anesthesia. A review > of dosages of the most commonly used local anesthetic drugs in dentistry and > the management of a toxic reaction is presented. Clinicians need to be in a > position to recognize and successfully manage this potential adverse > reaction. > > Publication Types: > Case Reports > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2005 Report Share Posted March 24, 2005 Barry, I thought you rode a Yamaha. Sorry. GG > > Rather judgmental statement don't you think Gene? > > Barry Meffert > > In a message dated 3/24/2005 2:24:25 PM Central Standard Time, > wegandy1938@... writes: > I've intubated a few swine in my day also.  Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene > > > > > > > > > Emerg Med J. 2001 Nov;18(6):453-7. > > > > In patients with head injury undergoing rapid sequence intubation, does > > pretreatment with intravenous lignocaine/lidocaine lead to an improved > > neurological outcome? A review of the literature. > > > > N, Clancy M. > > > > Emergency Department, Southampton General Hospital, Tremona Road, > > Southampton SO16 6YD, UK. poppabear66@... > > > > It is well known that laryngeal instrumentation and endotracheal > intubation > > is associated with a marked, transient rise in intracranial pressure > (ICP). > > Patients with head injury requiring endotracheal intubation are considered > > particularly at risk from this transient rise in ICP as it reduces > cerebral > > perfusion and thus may increase secondary brain injury. The favoured > method > > for securing a definitive airway in this patient group is by rapid > sequence > > intubation (RSI). In the United States the Emergency Airway Course teaches > > emergency physicians to routinely administer intravenous lidocaine as a > pre > > treatment for RSI in this patient group in an attempt to attenuate this > rise > > in ICP. A literature search was carried out to identify studies in which > > intravenous lidocaine was used as a pretreatment for RSI in major head > > injury. Any link to an improved neurological outcome was also sought. > Papers > > identified were appraised in the manner recommended by the evidence based > > medicine group to ensure validity. There were no studies identified that > > answered our question directly and, furthermore, it is our belief that no > > such study, at present, exists in the literature. Six valid papers were > > found, which individually contained elements of the question posed and > these > > are presented in a narrative and graphic form. There is currently no > > evidence to support the use of intravenous lidocaine as a pretreatment for > > RSI in patients with head injury and its use should only occur in clinical > > trials. > > > > Publication Types: > > Review > > Review, Tutorial > > > > ______________________________ > ______________________________________________ > > __- > > J Trauma. 2005 Feb;58(2):278-83. > > > > > > Intracranial pressure changes during rapid sequence intubation: a swine > > model. > > > > Bozeman WP, Idris AH. > > > > Department of Emergency Medicine, Wake Forest University School of > Medicine, > > Winston-Salem, NC 27157, USA. wbozeman@... > > > > BACKGROUND: Controversy and speculation exist regarding intracranial > > pressure (ICP) changes produced by various combinations of rapid sequence > > intubation (RSI) agents. In this pilot study, we sought to develop a swine > > model to investigate these changes in classic RSI. METHODS: Eight adult > > swine were instrumented with arterial and intracranial pressure monitors. > > Four different versions of rapid sequence intubation were then performed > > sequentially in each animal in a crossover trial design: regimen 1, > > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, > lidocaine, > > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > > thiopental, and succinylcholine. ICP and hemodynamic parameters were > > recorded and compared. Trials were excluded from analysis if baseline ICP > > measurements were unstable or if intubation was difficult. RESULTS: Peak > > changes in ICP were noted at 2 to 3 minutes after administration of > > induction agents. Mean values for peak changes in ICP were as follows: > > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm > Hg); > > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > > investigators to examine the aggregate ICP effects of combinations of RSI > > medications. RSI regimens with paralysis produced threefold increases in > > peak ICP change compared with the sedation-only regimen. Pretreatment > agents > > did not affect ICP changes. Future investigations can examine other agents > > and add experimental manipulation of ICP to simulate head injury > physiology. > > Additional parameters including cerebral metabolism and/or oxygenation may > > also be explored. > > > > > ____________________________________________________________________________ > > _______________________________ > > Lidocaine toxicity. > > > > Mehra P, Caiazzo A, Maloney P. > > > > Department of Oral and Maxillofacial Surgery, Boston University School of > > Dental Medicine, Massachusetts 02118, USA. > > > > Local anesthetics are the most commonly used drugs in dentistry. The > number > > of adverse reactions reported, particularly toxic reactions, are > > extraordinarily negligible. This article reports a case of lidocaine > > toxicity with its typical manifestation in a 37-yr-old healthy male. The > > toxic reaction followed transoral/transpharyngeal topical spraying of > > lidocaine preoperatively during preparation for general anesthesia. A > review > > of dosages of the most commonly used local anesthetic drugs in dentistry > and > > the management of a toxic reaction is presented. Clinicians need to be in > a > > position to recognize and successfully manage this potential adverse > > reaction. > > > > Publication Types: > > Case Reports > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2005 Report Share Posted March 24, 2005 Ah Gene, I know you group all of us organ donors into one category. Barry M In a message dated 3/25/2005 12:11:51 AM Central Standard Time, wegandy1938@... writes: Barry, I thought you rode a Yamaha. Sorry. GG > > Rather judgmental statement don't you think Gene? > > Barry Meffert > > In a message dated 3/24/2005 2:24:25 PM Central Standard Time, > wegandy1938@... writes: > I've intubated a few swine in my day also. Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2005 Report Share Posted March 24, 2005 Ah Gene, I know you group all of us organ donors into one category. Barry M In a message dated 3/25/2005 12:11:51 AM Central Standard Time, wegandy1938@... writes: Barry, I thought you rode a Yamaha. Sorry. GG > > Rather judgmental statement don't you think Gene? > > Barry Meffert > > In a message dated 3/24/2005 2:24:25 PM Central Standard Time, > wegandy1938@... writes: > I've intubated a few swine in my day also. Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2005 Report Share Posted March 24, 2005 Ah Gene, I know you group all of us organ donors into one category. Barry M In a message dated 3/25/2005 12:11:51 AM Central Standard Time, wegandy1938@... writes: Barry, I thought you rode a Yamaha. Sorry. GG > > Rather judgmental statement don't you think Gene? > > Barry Meffert > > In a message dated 3/24/2005 2:24:25 PM Central Standard Time, > wegandy1938@... writes: > I've intubated a few swine in my day also. Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2005 Report Share Posted March 25, 2005 I've always related low ICP in hawg riders to the relaxation index, but maybe I should have checked Jim Beam titers. Now there is a REAL paralytic for you. Larry > > Rather judgmental statement don't you think Gene? > > Barry Meffert > > In a message dated 3/24/2005 2:24:25 PM Central Standard Time, > wegandy1938@a... writes: > I've intubated a few swine in my day also. Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene > > > In a message dated 3/23/05 21:40:35, bbledsoe@e... writes: > > > > > > Emerg Med J. 2001 Nov;18(6):453-7. > > > > In patients with head injury undergoing rapid sequence intubation, does > > pretreatment with intravenous lignocaine/lidocaine lead to an improved > > neurological outcome? A review of the literature. > > > > N, Clancy M. > > > > Emergency Department, Southampton General Hospital, Tremona Road, > > Southampton SO16 6YD, UK. poppabear66@h... > > > > It is well known that laryngeal instrumentation and endotracheal intubation > > is associated with a marked, transient rise in intracranial pressure (ICP). > > Patients with head injury requiring endotracheal intubation are considered > > particularly at risk from this transient rise in ICP as it reduces cerebral > > perfusion and thus may increase secondary brain injury. The favoured method > > for securing a definitive airway in this patient group is by rapid sequence > > intubation (RSI). In the United States the Emergency Airway Course teaches > > emergency physicians to routinely administer intravenous lidocaine as a pre > > treatment for RSI in this patient group in an attempt to attenuate this rise > > in ICP. A literature search was carried out to identify studies in which > > intravenous lidocaine was used as a pretreatment for RSI in major head > > injury. Any link to an improved neurological outcome was also sought. Papers > > identified were appraised in the manner recommended by the evidence based > > medicine group to ensure validity. There were no studies identified that > > answered our question directly and, furthermore, it is our belief that no > > such study, at present, exists in the literature. Six valid papers were > > found, which individually contained elements of the question posed and these > > are presented in a narrative and graphic form. There is currently no > > evidence to support the use of intravenous lidocaine as a pretreatment for > > RSI in patients with head injury and its use should only occur in clinical > > trials. > > > > Publication Types: > > Review > > Review, Tutorial > > > > _____________________________________________________________________ _______ > > __- > > J Trauma. 2005 Feb;58(2):278-83. > > > > > > Intracranial pressure changes during rapid sequence intubation: a swine > > model. > > > > Bozeman WP, Idris AH. > > > > Department of Emergency Medicine, Wake Forest University School of Medicine, > > Winston-Salem, NC 27157, USA. wbozeman@w... > > > > BACKGROUND: Controversy and speculation exist regarding intracranial > > pressure (ICP) changes produced by various combinations of rapid sequence > > intubation (RSI) agents. In this pilot study, we sought to develop a swine > > model to investigate these changes in classic RSI. METHODS: Eight adult > > swine were instrumented with arterial and intracranial pressure monitors. > > Four different versions of rapid sequence intubation were then performed > > sequentially in each animal in a crossover trial design: regimen 1, > > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, > > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > > thiopental, and succinylcholine. ICP and hemodynamic parameters were > > recorded and compared. Trials were excluded from analysis if baseline ICP > > measurements were unstable or if intubation was difficult. RESULTS: Peak > > changes in ICP were noted at 2 to 3 minutes after administration of > > induction agents. Mean values for peak changes in ICP were as follows: > > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0- 6.2 mm Hg); > > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > > investigators to examine the aggregate ICP effects of combinations of RSI > > medications. RSI regimens with paralysis produced threefold increases in > > peak ICP change compared with the sedation-only regimen. Pretreatment agents > > did not affect ICP changes. Future investigations can examine other agents > > and add experimental manipulation of ICP to simulate head injury physiology. > > Additional parameters including cerebral metabolism and/or oxygenation may > > also be explored. > > > > _____________________________________________________________________ _______ > > _______________________________ > > Lidocaine toxicity. > > > > Mehra P, Caiazzo A, Maloney P. > > > > Department of Oral and Maxillofacial Surgery, Boston University School of > > Dental Medicine, Massachusetts 02118, USA. > > > > Local anesthetics are the most commonly used drugs in dentistry. The number > > of adverse reactions reported, particularly toxic reactions, are > > extraordinarily negligible. This article reports a case of lidocaine > > toxicity with its typical manifestation in a 37-yr-old healthy male. The > > toxic reaction followed transoral/transpharyngeal topical spraying of > > lidocaine preoperatively during preparation for general anesthesia. A review > > of dosages of the most commonly used local anesthetic drugs in dentistry and > > the management of a toxic reaction is presented. Clinicians need to be in a > > position to recognize and successfully manage this potential adverse > > reaction. > > > > Publication Types: > > Case Reports > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2005 Report Share Posted March 25, 2005 I've always related low ICP in hawg riders to the relaxation index, but maybe I should have checked Jim Beam titers. Now there is a REAL paralytic for you. Larry > > Rather judgmental statement don't you think Gene? > > Barry Meffert > > In a message dated 3/24/2005 2:24:25 PM Central Standard Time, > wegandy1938@a... writes: > I've intubated a few swine in my day also. Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene > > > In a message dated 3/23/05 21:40:35, bbledsoe@e... writes: > > > > > > Emerg Med J. 2001 Nov;18(6):453-7. > > > > In patients with head injury undergoing rapid sequence intubation, does > > pretreatment with intravenous lignocaine/lidocaine lead to an improved > > neurological outcome? A review of the literature. > > > > N, Clancy M. > > > > Emergency Department, Southampton General Hospital, Tremona Road, > > Southampton SO16 6YD, UK. poppabear66@h... > > > > It is well known that laryngeal instrumentation and endotracheal intubation > > is associated with a marked, transient rise in intracranial pressure (ICP). > > Patients with head injury requiring endotracheal intubation are considered > > particularly at risk from this transient rise in ICP as it reduces cerebral > > perfusion and thus may increase secondary brain injury. The favoured method > > for securing a definitive airway in this patient group is by rapid sequence > > intubation (RSI). In the United States the Emergency Airway Course teaches > > emergency physicians to routinely administer intravenous lidocaine as a pre > > treatment for RSI in this patient group in an attempt to attenuate this rise > > in ICP. A literature search was carried out to identify studies in which > > intravenous lidocaine was used as a pretreatment for RSI in major head > > injury. Any link to an improved neurological outcome was also sought. Papers > > identified were appraised in the manner recommended by the evidence based > > medicine group to ensure validity. There were no studies identified that > > answered our question directly and, furthermore, it is our belief that no > > such study, at present, exists in the literature. Six valid papers were > > found, which individually contained elements of the question posed and these > > are presented in a narrative and graphic form. There is currently no > > evidence to support the use of intravenous lidocaine as a pretreatment for > > RSI in patients with head injury and its use should only occur in clinical > > trials. > > > > Publication Types: > > Review > > Review, Tutorial > > > > _____________________________________________________________________ _______ > > __- > > J Trauma. 2005 Feb;58(2):278-83. > > > > > > Intracranial pressure changes during rapid sequence intubation: a swine > > model. > > > > Bozeman WP, Idris AH. > > > > Department of Emergency Medicine, Wake Forest University School of Medicine, > > Winston-Salem, NC 27157, USA. wbozeman@w... > > > > BACKGROUND: Controversy and speculation exist regarding intracranial > > pressure (ICP) changes produced by various combinations of rapid sequence > > intubation (RSI) agents. In this pilot study, we sought to develop a swine > > model to investigate these changes in classic RSI. METHODS: Eight adult > > swine were instrumented with arterial and intracranial pressure monitors. > > Four different versions of rapid sequence intubation were then performed > > sequentially in each animal in a crossover trial design: regimen 1, > > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, > > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > > thiopental, and succinylcholine. ICP and hemodynamic parameters were > > recorded and compared. Trials were excluded from analysis if baseline ICP > > measurements were unstable or if intubation was difficult. RESULTS: Peak > > changes in ICP were noted at 2 to 3 minutes after administration of > > induction agents. Mean values for peak changes in ICP were as follows: > > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0- 6.2 mm Hg); > > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > > investigators to examine the aggregate ICP effects of combinations of RSI > > medications. RSI regimens with paralysis produced threefold increases in > > peak ICP change compared with the sedation-only regimen. Pretreatment agents > > did not affect ICP changes. Future investigations can examine other agents > > and add experimental manipulation of ICP to simulate head injury physiology. > > Additional parameters including cerebral metabolism and/or oxygenation may > > also be explored. > > > > _____________________________________________________________________ _______ > > _______________________________ > > Lidocaine toxicity. > > > > Mehra P, Caiazzo A, Maloney P. > > > > Department of Oral and Maxillofacial Surgery, Boston University School of > > Dental Medicine, Massachusetts 02118, USA. > > > > Local anesthetics are the most commonly used drugs in dentistry. The number > > of adverse reactions reported, particularly toxic reactions, are > > extraordinarily negligible. This article reports a case of lidocaine > > toxicity with its typical manifestation in a 37-yr-old healthy male. The > > toxic reaction followed transoral/transpharyngeal topical spraying of > > lidocaine preoperatively during preparation for general anesthesia. A review > > of dosages of the most commonly used local anesthetic drugs in dentistry and > > the management of a toxic reaction is presented. Clinicians need to be in a > > position to recognize and successfully manage this potential adverse > > reaction. > > > > Publication Types: > > Case Reports > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2005 Report Share Posted March 25, 2005 If he rode a Yamaha his ICP WOULD be high. Larry > > Barry, > > I thought you rode a Yamaha. Sorry. > > GG > In a message dated 3/24/05 23:04:28, ultrahog2001@a... writes: > > > > > > Rather judgmental statement don't you think Gene? > > > > Barry Meffert > > > > In a message dated 3/24/2005 2:24:25 PM Central Standard Time, > > wegandy1938@a... writes: > > I've intubated a few swine in my day also.  Most were riding Harleys as I > > recall, so I naturally assumed low ICP to begin with. > > > > Gene > > > > > > In a message dated 3/23/05 21:40:35, bbledsoe@e... writes: > > > > > > > > > > Emerg Med J. 2001 Nov;18(6):453-7. > > > > > > In patients with head injury undergoing rapid sequence intubation, does > > > pretreatment with intravenous lignocaine/lidocaine lead to an improved > > > neurological outcome? A review of the literature. > > > > > > N, Clancy M. > > > > > > Emergency Department, Southampton General Hospital, Tremona Road, > > > Southampton SO16 6YD, UK. poppabear66@h... > > > > > > It is well known that laryngeal instrumentation and endotracheal > > intubation > > > is associated with a marked, transient rise in intracranial pressure > > (ICP). > > > Patients with head injury requiring endotracheal intubation are considered > > > particularly at risk from this transient rise in ICP as it reduces > > cerebral > > > perfusion and thus may increase secondary brain injury. The favoured > > method > > > for securing a definitive airway in this patient group is by rapid > > sequence > > > intubation (RSI). In the United States the Emergency Airway Course teaches > > > emergency physicians to routinely administer intravenous lidocaine as a > > pre > > > treatment for RSI in this patient group in an attempt to attenuate this > > rise > > > in ICP. A literature search was carried out to identify studies in which > > > intravenous lidocaine was used as a pretreatment for RSI in major head > > > injury. Any link to an improved neurological outcome was also sought. > > Papers > > > identified were appraised in the manner recommended by the evidence based > > > medicine group to ensure validity. There were no studies identified that > > > answered our question directly and, furthermore, it is our belief that no > > > such study, at present, exists in the literature. Six valid papers were > > > found, which individually contained elements of the question posed and > > these > > > are presented in a narrative and graphic form. There is currently no > > > evidence to support the use of intravenous lidocaine as a pretreatment for > > > RSI in patients with head injury and its use should only occur in clinical > > > trials. > > > > > > Publication Types: > > > Review > > > Review, Tutorial > > > > > > ______________________________ > > ______________________________________________ > > > __- > > > J Trauma. 2005 Feb;58(2):278-83. > > > > > > > > > Intracranial pressure changes during rapid sequence intubation: a swine > > > model. > > > > > > Bozeman WP, Idris AH. > > > > > > Department of Emergency Medicine, Wake Forest University School of > > Medicine, > > > Winston-Salem, NC 27157, USA. wbozeman@w... > > > > > > BACKGROUND: Controversy and speculation exist regarding intracranial > > > pressure (ICP) changes produced by various combinations of rapid sequence > > > intubation (RSI) agents. In this pilot study, we sought to develop a swine > > > model to investigate these changes in classic RSI. METHODS: Eight adult > > > swine were instrumented with arterial and intracranial pressure monitors. > > > Four different versions of rapid sequence intubation were then performed > > > sequentially in each animal in a crossover trial design: regimen 1, > > > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, > > lidocaine, > > > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > > > thiopental, and succinylcholine. ICP and hemodynamic parameters were > > > recorded and compared. Trials were excluded from analysis if baseline ICP > > > measurements were unstable or if intubation was difficult. RESULTS: Peak > > > changes in ICP were noted at 2 to 3 minutes after administration of > > > induction agents. Mean values for peak changes in ICP were as follows: > > > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm > > Hg); > > > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > > > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > > > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > > > investigators to examine the aggregate ICP effects of combinations of RSI > > > medications. RSI regimens with paralysis produced threefold increases in > > > peak ICP change compared with the sedation-only regimen. Pretreatment > > agents > > > did not affect ICP changes. Future investigations can examine other agents > > > and add experimental manipulation of ICP to simulate head injury > > physiology. > > > Additional parameters including cerebral metabolism and/or oxygenation may > > > also be explored. > > > > > > > > _____________________________________________________________________ _______ > > > _______________________________ > > > Lidocaine toxicity. > > > > > > Mehra P, Caiazzo A, Maloney P. > > > > > > Department of Oral and Maxillofacial Surgery, Boston University School of > > > Dental Medicine, Massachusetts 02118, USA. > > > > > > Local anesthetics are the most commonly used drugs in dentistry. The > > number > > > of adverse reactions reported, particularly toxic reactions, are > > > extraordinarily negligible. This article reports a case of lidocaine > > > toxicity with its typical manifestation in a 37-yr-old healthy male. The > > > toxic reaction followed transoral/transpharyngeal topical spraying of > > > lidocaine preoperatively during preparation for general anesthesia. A > > review > > > of dosages of the most commonly used local anesthetic drugs in dentistry > > and > > > the management of a toxic reaction is presented. Clinicians need to be in > > a > > > position to recognize and successfully manage this potential adverse > > > reaction. > > > > > > Publication Types: > > > Case Reports > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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