Topical Anesthesia with 10% Lidocaine Spray

Application and Dosage

• The Difficult Airway Society guidelines indicate that 10% lidocaine spray can be used with relatively rapid onset for awake tracheal intubation procedures, with an onset time of 2-5 minutes 1
• The total dose of topical lidocaine should not exceed 9 mg/kg lean body weight, with one spray of 10% lidocaine delivering 10 mg of medication 1
• Monitor for signs of systemic toxicity, including perioral numbness, tinnitus, metallic taste, and visual disturbances, when using topical lidocaine 2, 3

Safety and Contraindications

• Do not use concurrent local anesthetic interventions within 4 hours of topical lidocaine application if transitioning to systemic lidocaine, as this increases the risk of toxicity 4, 5, 6

Duration of Action

• The duration of action for topical lidocaine formulations is 30-60 minutes 1