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Re: RSI Drugs

By Guest guest, in Health, Medicine and Natural Healing 05

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Guest guest   

Guest guest
Posted

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

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Guest guest   

Guest guest
Posted

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

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Guest guest   

Guest guest
Posted

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

>

>

>

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Guest guest   

Guest guest
Posted

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

>

>

>

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Guest guest   

Guest guest
Posted

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

>

>

>

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Guest guest   

Guest guest
Posted

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

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Guest guest   

Guest guest
Posted

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

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Guest guest   

Guest guest
Posted

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

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Guest guest   

Guest guest
Posted

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

>

>

>

>

>

>

>

Share this post

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Guest guest   

Guest guest
Posted

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

>

>

>

>

>

>

>

Share this post

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Share on other sites

Guest guest   

Guest guest
Posted

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

>

>

>

>

>

>

>

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Guest guest   

Guest guest
Posted

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.

>  

> 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

>

>

>

>

>

>

>

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Guest guest   

Guest guest
Posted

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.

>  

> 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

>

>

>

>

>

>

>

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Guest guest   

Guest guest
Posted

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.

>  

> 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

>

>

>

>

>

>

>

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Guest guest   

Guest guest
Posted

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

Share this post

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Guest guest   

Guest guest
Posted

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

>

>

>

>

>

>

>

Share this post

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Guest guest   

Guest guest
Posted

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

>

>

>

>

>

>

>

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Guest guest   

Guest guest
Posted

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

>

>

>

>

>

>

>

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Guest guest   

Guest guest
Posted

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

> >

> >

> >

> >

> >

> >

> >

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Guest guest   

Guest guest
Posted

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

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Guest guest   

Guest guest
Posted

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

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Guest guest   

Guest guest
Posted

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

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Guest guest   

Guest guest
Posted

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

> >

> >

> >

> >

> >

> >

> >

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Guest guest   

Guest guest
Posted

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

> >

> >

> >

> >

> >

> >

> >

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Guest guest   

Guest guest
Posted

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

> > >

> > >

> > >

> > >

> > >

> > >

> > >

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