Lidocaine for Laryngoscopic Surge Suppression

Administration and Efficacy

The American Academy of Pediatrics recommends a dose of 1-2 mg/kg IV as a single dose 30 seconds to 5 minutes before airway instrumentation for laryngoscopic surge suppression 1
Intravenous lidocaine is more effective than topical application for preventing laryngospasm in healthy children with LMA, and reducing post-extubation laryngospasm in healthy children, as suggested by the Anaesthesia journal 2

When using lidocaine for laryngoscopic surge suppression, consider total dose from all sources to avoid local anesthetic toxicity, as noted by the Anaesthesia journal 2
Brief duration of effect suggests administration within 5 minutes before airway manipulation, according to the Anaesthesia journal 2
In children with upper respiratory infections, the evidence does not strongly support using lidocaine (IV or topical) to decrease perioperative respiratory adverse events, as reported by the Anaesthesia journal 3, 2
Some studies report increased risk of desaturation, laryngospasm, and bronchospasm with topical lidocaine in children, as noted by the Anaesthesia journal 3

For patients with COVID-19 requiring intubation, periodical injection of 2% lidocaine (2-3 ml) or 1% lidocaine (4-6 ml) through the working channel can reduce irritation during airway manipulation, as suggested by the Anesthesiology (ASA) journal 4
In children with increased risk of perioperative respiratory adverse events, IV lidocaine may reduce post-extubation laryngospasm, according to the Anaesthesia journal 2