Canadian Journal of Anesthesia, Vol 31, 497-502, Copyright © 1984 by Canadian Anesthesiologists' Society

Reports of Investigation: A Comparison of Pretreatment Regimens for Minimizing the Haemodynamic Response to Blind Nasotracheal Intubation

¹ Departments of Anesthesia, Nazareth Hospital, University of Pennsylvania, and Philadelphia Veterans Administration Medical Center, Philadelphia, PA

Address correspondence to: Dr. Jeffrey B. Gross, Department of Anesthesia (112), Philadelphia Veterans Administration Medical Center, University and Woodland Avenues, Philadelphia, PA 19104, USA

The authors determined the cardiovascular effects of blind nasotracheal intubation in four randomized groups of 25 patients each. After induction of anaesthesia with IV thiopentone 4 mg·kg^-1, patients in group A received no pretreatment, while patients in group B received IV lidocaine 1.5 mg·kg^-1. Three minutes before induction, patients in group C received 0.25 per cent phenylephrine nasal spray (0.2 mg in each nostril); those in group D received ten per cent lidocaine nasal spray (30 mg in each nostril). After intubation, mean arterial pressures (MAP) were highest in group B (IV lidocaine) patients (p < 0.05), remaining significantly elevated for 5 min. Conversely, within four minutes after intubation, MAP of group D (ten per cent nasal lidocaine spray) patients were below control (p < 0.05), and lower than those of any other group (p < 0.05). MAP of group A and C patients increased after intubation, but not as much as in group B patients (p < 0.05). There were no adverse effects from the lidocaine nasal spray. Ten per cent lidocaine nasal spray is a safe and effective way to minimize the MAP increases which typically accompany blind nasotracheal intubation in lightly anaesthetized patients.

Key Words: ANAESTHETICS, LOCAL: lidocaine • INTUBATION: nasotracheal • SYMPATHETIC NERVOUS SYSTEM: sympathomimetic agents, phenylephrine