The Beneficial Role of Endotracheal Lidocaine in Mitigating Hemodynamic Responses During Elective Surgical Tracheostomy in Head and Neck Cancer Patients

Abstract

BackgroundThe effectiveness of endotracheal lidocaine administration to reduce sympathetic stimulus after tracheostomy is still uncertain. PurposeThis study aimed to compare the hemodynamic responses of patients undergoing tracheostomy with and without pre-tracheostomy administration of endotracheal lidocaine. Study design, setting and sampleProspective cohort study conducted at a tertiary care cancer center in the United Kingdom. Patients who underwent tracheostomy as part of their head and neck cancer surgery were included. Exclusion criteria comprised tracheostomies involving special requirements and subjects with documented cardiac history or taking specific medications. Predictor VariableThe predictor variable was pre-tracheostomy anesthetic management defined as the administration of endotracheal 4ml 4% lidocaine before tracheostomy coded as lidocaine used or not used. Outcome VariableThe primary outcome measures in this study were the observed hemodynamic responses after tracheostomy, including heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP). The secondary outcome measure in the two groups was the time it took for subjects to return to their pre-tracheostomy baseline hemodynamic parameters, measured in minutes. AnalysesData analyses included chi-square, t-test, ANOVA and multivariable regression models. P values <.05 were considered statistically significant. CovariatesThe patients’ age, sex, body mass index (BMI), smoking status, tracheostomy tube size and tumor stage were evaluated. ResultsThe sample included 50 consecutive patients, the majority of whom were male (55%) with a mean age of 62 years (SD 12) and mean BMI of 28 (SD 4). Most patients had stage III or IV oral cancers (59%). Following surgical tracheostomy, the group whom received endotracheal lidocaine demonstrated significantly less hemodynamic variability when compared with the control group. The case group exhibiting lower SBP (117 [SD 10] vs. 136 [SD 18]), DBP (62 [SD 4] vs. 68 [SD 4]), and HR (72 [SD 4] vs. 78 [SD 4]), with statistical significance (p<0.05). However, there was no significant difference in the time taken for the two groups to return to their pre-tracheostomy baseline hemodynamic parameters. Conclusions and RelevanceThis study demonstrates an association between the pre-administration of 4% endotracheal lidocaine with an observed attenuation in hemodynamic response following surgical tracheostomy in head and neck cancer patients.