From the Guidelines
Nebulized lidocaine 1% should be used as an adjunctive therapy to reduce cough, prevent bronchospasm, and provide airway anesthesia in specific clinical scenarios, with a typical dosage ranging from 2-5 mL of 1% lidocaine solution (20-50 mg) administered via nebulizer, and the maximum recommended dose not exceeding 5 mg/kg to avoid systemic toxicity, as supported by the guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures 1.
Indications and Usage Guidelines
The indications for nebulized lidocaine 1% include:
- Pre-treatment before bronchoscopy to suppress cough reflexes and reduce discomfort
- Management of refractory or intractable cough that hasn't responded to conventional treatments
- Prevention of bronchospasm during intubation or airway manipulation
- Palliative care for dyspnea in terminal patients
Dosage and Administration
The typical dosage of nebulized lidocaine 1% ranges from 2-5 mL of 1% lidocaine solution (20-50 mg) administered via nebulizer, with the maximum recommended dose not exceeding 5 mg/kg to avoid systemic toxicity, as stated in the guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures 1.
Monitoring and Side Effects
Patients should be monitored for potential side effects including throat numbness, hoarseness, metallic taste, and rarely, systemic effects such as dizziness or cardiac arrhythmias, as mentioned in the guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures 1.
Mechanism of Action
Lidocaine works by blocking sodium channels in sensory nerve fibers, thereby interrupting the transmission of pain and irritation signals and reducing the cough reflex, as supported by the guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures 1.
Clinical Context
It's essential to note that nebulized lidocaine is often used off-label for many of these indications, and treatment should be individualized based on patient response and clinical context, as stated in the guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures 1. Some key points to consider when using nebulized lidocaine 1% include:
- The choice of treatment may be dictated primarily by availability rather than pharmacologic parameters, as mentioned in the symptomatic treatment of cough among adult patients with lung cancer: chest guideline and expert panel report 1.
- Local anesthetics, such as nebulized lidocaine, have been suggested to be helpful in case studies and are commonly used in palliative care for intractable cough that has not responded to any other approaches, as supported by the symptomatic treatment of cough among adult patients with lung cancer: chest guideline and expert panel report 1.
- Aspiration risk should be assessed prior to the use of this type of treatment for cough, as mentioned in the symptomatic treatment of cough among adult patients with lung cancer: chest guideline and expert panel report 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Indications for Nebulized Lidocaine 1%
- Nebulized lidocaine 1% is used as a local anesthetic for procedures such as bronchoscopy 2, 3, 4, 5, 6
- It is used to produce topical anesthesia of the respiratory tract, allowing for comfortable and safe performance of bronchoscopic examinations 2, 3, 4, 5, 6
Usage Guidelines
- The recommended dose of nebulized lidocaine varies, but studies have used doses ranging from 1% lidocaine, 0.2 to 0.3 mL/kg, with a total volume of 10 to 20 mL 4
- Nebulized lidocaine can be administered using an ultrasonic nebulizer or an air-powered nebulizer 2, 3
- The safety and efficacy of nebulized lidocaine have been demonstrated in both adults and children, with low systemic absorption and minimal side effects 2, 3, 4, 5, 6
Safety and Efficacy
- Studies have shown that nebulized lidocaine is safe and effective for use in bronchoscopy, with peak plasma concentrations remaining below toxic levels 2, 3, 4, 5, 6
- Nebulized lidocaine has been compared to standard local application of lidocaine, with results showing reduced consumption of lidocaine and sedative drugs, as well as improved patient tolerance 6
- The use of nebulized lidocaine has been found to be well-tolerated and safe in infants and children, with low serum lidocaine levels and minimal side effects 5