Take Home Point:

• There exists no evidence that in acute traumatic brain injury, pretreatment with intravenous (IV) lidocaine before rapid sequence intubation (RSI) reduces intracranial pressure (ICP) or improves neurologic outcomes.

Summary:
The administration of IV lidocaine has been hypothesized to suppress a potential, transient increase in ICP caused by RSI. 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

The role of IV lidocaine in suppressing ICP during RSI is extrapolated from studies examining the effect of IV lidocaine on cough suppression, ICP blunting during endotracheal suctioning, and ICP blunting during neurosurgery on patients with intracranial masses. No studies have been conducted that have measured ICP during RSI in patients with acute head injuries as this would be impractical and infeasible. A possible rise in ICP in this patient population, and the potential ICP blunting effect of IV lidocaine is extrapolated from the afore mentioned population studies.

There exists no evidence regarding any improvement in neurological outcome in those patients with acute head injury that are treated with IV lidocaine prior to RSI.

Author:  Karolina DeAugustinis, MD
Editor(s):  Anthony J. Busti, MD, PharmD, FNLA, FAHA
Date Last Reviewed:  August 2015