EBM Consult

Lidocaine Prior to Rapid Sequence Intubation in Patients with Traumatic Brain Injuries

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.


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
  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 rapid sequence intubation (RSI).

Landmark or Original Studies

  • Bedford et al. Lidocaine or Thiopental for Rapid Control of Intracranial Hypertension? Anesthesia & Analgesia 1980:59(6), 435-437. PubMed
  • Robinson et al. In patients with head injury undergoing rapid sequence intubation, does pretreatment with intravenous lignocaine/lidocaine lead to an improved neurological outcome? A review of the literature. E Med J 2001:18(6), 453-457. PubMed

Related Articles

  • Steinhaus et al. A study of intravenous lidocaine as a suppressant of cough reflex. Anesthesiology 1962:24, 285-290.
  • Poulton et al. Cough suppression by lidocaine. Anesthesiology 1979:50(5), 470-472.
  • Donegan et al. Intravenously administered lidocaine prevents intracranial hypertension during endotracheal suctioning. Anesthesiology 1980:52:516-18.

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MESH Terms or Keywords

  • Lidocaine Prior RSI, Lidocaine Rapid Sequence Intubation, Lidocaine RSI Traumatic Brain Injury, Lidocaine Increased Intracranial Pressure