Lidocaine

[MAC10]

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I just luv using lidocaine at the end of the case to aid with a smoother wake up. Ive found that pts wake up without alot of coughing and bucking, they are comfortable breathing through the tube and will follow commands. So, I was surprised when someone told me that it shouldnt use it because it delays waking up. This is not what ive seen from my limited experience. Does anyone have any facts or experience to support this?

 

[coccygodynia]

I've heard the same thing, but haven't seen it. I was just assuming they meant if I gave a large dose (>3mg/kg) since sedation is one of the first neurologic signs of lido toxicity ... but who the hell gives that much lido with wakeup? I'm with you - it has made for some remarkably smooth extubations with my patients.

How much of a dose are you giving?

 

[MAC10]

Usually 1mg/kg.

I usually give the same at induction though. Total 2mg/kg

 

[dA pilot]

It may delay wakeup because pt is too comfortable. You would have to get more gas off.

I also believe the dose to blunt coughing or bucking on the tube is 1.5mg/kg.

 

[Noyac]

Lidocaine can delay wakeup but it depends on how you use it. Things like how much narcotics, at what time did you give it, length of the case, etc. I personally don't use it very often (induction or emergence). Its just a personal thing. There are alot of ways to prevent coughing, like narcotics, deep extubations, propofol to name a few. YOur goal should be an awake and comfortable patient, extubated or ready for extubation, when the surgeons are reaching for the drapes. Use your residency to practice these skills whether it is with lido or not.

 

[MAC10]

Lidocaine can delay wakeup but it depends on how you use it. Things like how much narcotics, at what time did you give it, length of the case, etc. I personally don't use it very often (induction or emergence). Its just a personal thing. There are alot of ways to prevent coughing, like narcotics, deep extubations, propofol to name a few. YOur goal should be an awake and comfortable patient, extubated or ready for extubation, when the surgeons are reaching for the drapes. Use your residency to practice these skills whether it is with lido or not.

What narcotic and dose do you use at the end of the case? Does this delay emergence? I used Lido on every case today and im more and more amazed each time. Once all your gas is blown off you are money. It has taken my game from a few popped stiches to some of the slickest wake ups ive seen.

 

[Noyac]

Narcotic dose is arbitrary. I get the patient breathing and titrate narcs (usually morphine or fentanyl) to a resp rate of 12-16. This seems to work well for me. I think lido is fine but when they are breathing at this rate they are comfy when they get to the PACU. I like morphine better because of the duration. They spend less time in the PACU and are out the door. If I am at the surgery center this is great because the sooner they leave the sooner I leave. Granted, this is just one technique. There are obviously many others and I frequently stray from this technique. For instance, I will give less narcs to a morbidly obese patient with OSA. The bottom line is that you should try different techniques and get comfortable with all forms of emergence. As you know different patients require different types of anesthesia. You can't put everyone to sleep and wake everyone up the same way. There are some anesth. providers out there that do it the same way every time and believe me there is a difference.