From the Research
Nebulized lidocaine (1% solution) in pediatric patients is typically recommended at a dose of 2-4 mg/kg (maximum 100 mg) for specific indications such as reducing cough and preventing bronchospasm during airway procedures, as supported by the most recent study 1. The medication should be administered via a standard nebulizer over 10-15 minutes, approximately 5-10 minutes before the procedure.
- Key considerations for administration include:
- Monitoring for potential side effects including throat numbness, metallic taste, and rarely, systemic toxicity
- Ideal administration of the first dose in a monitored setting
- Use of preservative-free formulations when available
- Recognition of this as an off-label use in pediatrics
- The effectiveness of nebulized lidocaine can vary between patients, and alternative therapies should be considered if an inadequate response occurs after 2-3 doses.
- Lidocaine works by blocking sodium channels in sensory nerves, reducing cough reflex sensitivity and providing local anesthesia to the airway mucosa.
- For ongoing management of refractory cough, it may be given every 6-8 hours as needed, with careful consideration of the maximum dose and potential for systemic toxicity, as noted in studies such as 2 and 3.
- It is crucial to prioritize the safety and efficacy of nebulized lidocaine in pediatric patients, given the lack of national or international consensus on recommended dosing, as highlighted in 1.