Lidocaine and Rapid Sequence Intubation

July 2005

Lidocaine and Rapid Sequence Intubation

Search Strategy: Scanning Rosen’s textbook, you note several references to the use of lidocaine which deal with the effect on tachycardia, hypertension, and intra-ocular pressure. Choosing Lev’s review article, you perform a search for references which have cited Lev on Web of Science. This search strategy yields Bozeman’s article below as well as a review article in Chest from 2005. Scanning the bibiliography lists from Lev’s article and the Chest review yields two more promising articles by Robinson and Hamil.

A 50 year old male motor vehicle accident victim presents to your ED by ambulance as the unrestrained driver of a head-on collision with another vehicle traveling about 60 mph. He had extracted himself from his car before he began feeling nauseous and then light-headed. He remembers nothing else except awakening on the ground surrounded by people, including the paramedics. EMS personnel report a groggy, but awake patient when they arrived with no eyewitness reports of seizure-like activity. The patient reports no past medical history. He denies all symptoms on review of systems but appears confused and intermittently agitated with a large left parietal scalp laceration not actively bleeding noted on your initial survey.

On physical exam you note the following vital signs: BP 115/80, P 112, R 18, T 36.7°, 87% on room air. During your primary survey you decide to intubate him. As you discuss this with your attending physician, you are asked by nursing for your medication orders in preparation for rapid sequence intubation. You quickly bark out “Lidocaine, defasciculating dose of Vecuronium, and Succinylcholine.” Your attending questions your use of lidocaine which you justify in this potentially head-injured patient to prevent further neurological injury. You are challenged to present the evidence of a benefit of pre-treatment with lidocaine in head-injured patients during rapid sequence intubation.

PICO Question

Population: Trauma patients with potential head injury

Intervention: Lidocaine with rapid sequence intubation

Comparison: RSI without lidocaine

Outcome: Mortality, Morbidity, Hospital Length of Stay, Effect on Other ED Patients


First years: Intracranial Pressure Changes During Rapid Sequence Intubation: A Swine Model. J Trauma 2005; 58: 278-283.

Second years: Prophylactic Lidocaine Use Preintubation: A Review. J of EM 1994; 12: 499-506.

Third years: Lidocaine Before Endotracheal Intubation: Intravenous or Laryngotracheal? Anesthesiology 1981; 55: 578-581.

Fourth years: 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. Emerg Med J 2001; 18: 453-457.


First, Third Year Residents: use the Therapy Critical Review Form

Second, Fourth Year Residents: use the Meta-Analysis Critical Review Form


Article 1: ICP Change During RSI, Swine Model—J Trauma 2005; 58: 278-283

Article 2: Prophylactic Lidocaine Use Preintubation: A Review, J EM 1994; 12: 499-506

Article 3: Lidocaine Before Endotracheal Intubation: IV or Laryngotracheal? Anesthesiology 1981; 55: 578-581

Article 4: In Patients with Head Injury Undergoing RSI, Does Pretreatment with IV Lidocaine Lead to an Improved Neurological Outcome? A Review of the Literature, EMJ 2001; 18: 453-457