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bupivacaine 0.25% nebulisation for post tracheostomy cough
- Manoj Sharma, Amita Sharma (24 October 2005)
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Not all light-headedness is local anaesthetic toxicity
- Kar-Soon Lim (17 October 2005)
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Manoj Sharma, Anaesthetist Frenchay hospital,Bristol, UK, Amita Sharma
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We read this article about awake fibreoptic intubation with combination of nebulisation and topical local anaesthesia.
Its interesting to know that unsedated patients could have good intubating condtions with just local airway anaesthesia.
In ICU, I have seen three recently tracheostomised patients who were being weaned off the ventilatory support and sedation. But as they woke up,they started coughing violently with consequent rise in BP and tachycardia. They were resedated and put back on ventiltory support.
Then we tried Lidocaine 1% 5ml instilation through tracheostomy tube to avoid coughing. It helped a little but couldn't avoid coughing. Consequently, we tried nebulised 0.25% bupivacaine 5-10 ml.It worked brilliantly and the patients tolerated the tracheostomy tube well.We could successfully weaned off sedation and ventilatory support in these three patients.
Conflict of Interest:None declared |
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Kar-Soon Lim, Anaesthetic Registrar Repatriation General Hospital, Concord NSW Australia
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Dear Editor, I read with interest the study by Williams et al. I recently volunteered to undergo an awake fibreoptic intubation for teaching purposes. After nebulising a total of 8mL of 2% ignocaine plus adrenaline 1:200000 over 15 minutes, I felt lightheaded, which was initially interpreted as possible early local anaesthetic toxicity. I then developed classical Trousseau's sign in my hand when a NIBP cuff was inflated. It seemed likely that I had been hyperventilating to better inhale the lignocaine, and this had caused both a decrease in ionized calcium leading to tetany, as well as cerebral vasoconstriction leading to lightheadedness. The dose of lignocaine administered (160mg) was unlikely to cause toxicity. My symptoms abated and the procedure continued (with additional lignocaine) with no ill effect. Yours sincerely, Dr Kar-Soon Lim Anaesthetic Registrar Repatriation General Hospital, Concord Hospital Road Concord NSW 2139 Australia karsoonlim@ozemail.com.au Conflict of Interest:None declared |
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