Nebulized lidocaine and fentanyl before sevoflurane induction of anesthesia in congenital diaphragmatic hernia repair: Prospective double blind randomized study

Abstract

Introduction: Gastric overdistension by mask ventilation during induction of anesthesia in congenital diaphragmatic hernia (CDH) repair may worsen hypoxemia. Topical airway anesthesia may improve the intubating conditions during sevoflurane induction without muscle relaxation. The present study was designed to evaluate the effect of nebulized lidocaine and fentanyl on the intubating conditions without muscle relaxation during sevoflurane induction of anesthesia in infants undergoing CDH repair. The secondary aim was studying hemodynamic changes during induction. Patients and methods: Forty patients scheduled for (CDH) repair were randomly selected and blindly categorized to the following: Nebulizer group: Nebulized solution of 4 mg kg−1 lidocaine 1% plus 2 μg kg−1 fentanyl, Control group: Nebulized solution of comparable volume/weight normal saline 0.9%. Nebulizer of either solution was applied 15 min before sevoflurane induction. Results: Heart rate (HR) and mean arterial blood pressure (mABP) statistically significantly increased in the control group following intubation and for 2 min regarding HR and for 5 min regarding mABP in comparison with the base line and relative to the nebulizer group. There was a statistical significant improvement regarding the intubation conditions in the nebulizer group relative to the control group (p ⩽ 0.001). The same was noticed regarding the intubation time and the number of intubation attempts (p ⩽ 0.001). Conclusions: Premedication of infants undergoing CDH repair with nebulized solution containing 4 mg kg−1 lidocaine 1% plus 2 μg kg−1 fentanyl improves the intubating conditions under inhalational sevoflurane induction without muscle relaxation. The studied combination can suppress patients’ hemodynamic changes to intubation.

Keywords

• Fentanyl
• Lidocaine
• Nebulized
• Sevoflurane