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IV Lidocaine to Blunt the Increases in ICP with Endotracheal Suctioning

Take Home Point:

  • Evidence regarding the ability of intravenous (IV) lidocaine to suppress transient increases in increased cranial pressure (ICP) with endotracheal suctioning is mixed and does not evaluate the relevance of treating a potential, transient rise in ICP on neurologic outcome.  


The administration of IV lidocaine has been reported to suppress the potential rise in intracranial pressure (ICP) caused by endotracheal suctioning. This would be particularly important for patients with acute head injuries, where elevations in ICP are purported to compromise neurological outcomes.

IV lidocaine is hypothesized to work by two mechanisms:

  • By blunting the cough reflex, and thus the reflexive rise in ICP
  • By suppressing the "pressor response" - the rise in heart rate and blood pressure caused by a catecholamine release during endotracheal stimulation

Evidence in support of the use of IV lidocaine for ICP reduction during endotracheal suctioning is based on a number of small, underpowered studies examining either intubated ICU patients or healthy volunteers conducted several decades ago. Intracranial pressure was measured in the majority of the studies via a subarachnoid pressure screw, and cohorts included an average number of 10. These early studies reported a significant decrease in the observed cough reflex and blunting of any increase in ICP with suctioning. Methods and results were incompletely reported.

Relatively more recent evidence, including a randomized study by White et al., reject the efficacy of IV lidocaine in reducing ICP and suggest that cerebral perfusion pressure (CPP) is not altered at all during endotracheal suctioning due to a concomitant rise in mean arterial pressure (MAP) with suctioning (CCP=MAP-ICP).

All studies used a standard dose of IV lidocaine at 1.5 mg/kg. No studies reported the effect on neurological outcome and therefore raise questions as to the relevance of the proposed treatment.

  Karolina DeAugustinis, MD
  Anthony J. Busti, MD, PharmD, FNLA, FAHA
Date Last Reviewed:
August 2015

Supporting Guidelines

  • To our knowledge there are no guidelines or position statements by any professional organization that recommend lidocaine be used prior to endotracheal suctioning of patients with concerns for increased intracranial pressure (ICP).

Landmark or Original Studies

  • Donegan et al. Intravenously administered lidocaine prevents intracranial hypertension during endotracheal suctioning. Anesthesiology 1980:52:516-18. PubMed
  • Poulton et al. Cough suppression by lidocaine. Anesthesiology 1979:50(5), 470-472. PubMed
  • White et al. A randomized study of drugs for preventing increases in intracranial pressure during endotracheal suctioning. Anesthesiology 1982:57:242-4. PubMed

Related Articles

  • Takeshima et al. Cardiovascular response to rapid anaesthesia induction and endotracheal intubation. Anaesth Analg 1964;43:201-8.
  • Steinhaus et al. A study of intravenous lidocaine as a suppressant of cough reflex. Anesthesiology 1962:24, 285-290.

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MESH Terms or Keywords

  • Lidocaine Prevention ICP ET Suctioning, Preventing Increases in ICP with Lidocaine