Abstract
Objective
To assess if two different forms of upper airway topical anaesthesia induce similar changes in airway flow resistance (Rrs).
Design
Serial measurements of Rrs before and after topical anaesthesia with acqueous or paste lidocaine.
Setting
Lung function test laboratory.
Participants
9 normal men with documented normal lung function tests.
Interventions
2 different session of topical upper airway anaesthesia with 100 mg of liquid 5% lidocaine and 100 mg of 2% lidocaine paste, respectively.
Measurements and results
Rrs was measured by the random noise forced oscillation technique. Fiberoptic upper airway examination was performed in two subjects. Rrs increased on average by 81% after lidocaine spray and by 68% after lidocaine paste (p<0.005, respectively) with no difference in the magnitude of Rrs increase between the two modes of anaesthesia studied. This increase lasted 13±3 min (spray) and 12±3 min (paste), respectively (p=ns). Fiberoptic examination of the two most responders showed inspiratory laryngeal collapse.
Conclusions
Topical upper airway anaesthesia transiently increases Rrs with no specific effects regarding the drug presentation. Laryngeal dysfunction may be one mechanisms involved in Rrs increase following upper airway topical anaesthesia. Such findings may explain some poor respiratory tolerance reported during endoscopy.
Similar content being viewed by others
References
DeWeese EL, Sullivan TY (1988) Effect of upper airway anaesthesia on pharyngeal patency during sleep. J Appl Physiol 64:1346–1353
Chadwick GA, Crowley P, Fitzgerald MX, O'Regan RG, NcNicholas WT (1991) Obstructive sleep apnea following oropharyngeal anaesthesia in loud snorers. Am Rev Respir Dis 143: 810–813
Belen J, Neuhaus A, Markowitz D, Rotman HH (1981) Modification of the effect of fiberoptic bronchoscopy on pulmonary mechanics. Chest 79:516–519
Liistro G, Stanaescu DC, Veriter C, Rodenstein DO, D'Odemont JP (1992) Upper airway anaesthesia induces airflow limitation in awake humans. Am Rev Respir Dis 146:581–585
Lorino H, Mariette C, Karouia M, Lorino AM (1993) Influence of signal processing on estimation of respiratory impedance. J Appl Physiol 74:215–223
Altman DG (1991) Practical statistics for medical research. Chapman & Hall, London
Ferris BG Jr, Mead J Opie LH (1964) Partitioning of respiratory flow resistance in man. J Appl Physiol 19:653–658
Spann RW, Hyatt RE (1971) Factors affecting upper airway resistance in conscious man. J Appl Physiol 31:708–712
Peslin R, Fredberg JJ (1986) Oscillation mechanics of the respiratory system. In: Handbook of physiology. American Physiological Society, sect 3, vol III, part 1. Bethesda, p 145–177
Brochard L, Pelle G, DePalmas J, Brochard P, Carré A, Lorino H, Harf A (1987) Density and frequence dependence of resistance in early airway obstruction. Am Rev Respir Dis 135:579–584
DuBois AB (1969) Significance of measurement of airway resistance. Prog Respir Res 4:109–115
White DP, Lombard RM, Cadieux RJ, Zwillich CW (1985) Pharyngeal resistance in normal humans: influence of gender, age and obesity. J Appl Physiol 58:365–371
Baier H, Wanner A, Zarzecki S, Sackner MA (1977) Relationships among glottis opening, respiratory flow, and upper airway resistance in humans. J Appl Physiol 43:603–611
Kuna ST, Woodson GE, Sant'Ambrogio G (1988) Effect of laryngeal anaesthesia on pulmonary function testing in normal subjects. Am Rev Respir Dis 137:656–661
Kirkpatrick MB, Sanders RV, Bass JB (1987) Physiologic effects and serum lidocaine concentrations after inhalation of lidocaine from a compressed gas-powered jet nebulizer. Am Rev Respir Dis 136:447–449
Enright PL, McNally JF, Souhrada JF (1980) Effect of lidocaine on the ventilatory and airway response to exercise in asthmatics. Am Rev Respir Dis 122: 823–828
England SJ, Bartlett D Jr, Daubenspeck JA (1982) Influence of human vocal chord movements on airflow and resistance during eupnea. J Appl Physiol 52:773–779
Reemers JE, DeGroot WJ, Sauerland EK, Anch AM (1978) Pathogenesis of upper airway occlusion during sleep. J Appl Physiol 44:931–938
Brouillette RT, Thach BT (1979) A neuromuscular mechanism maintaining extrathoracic airway patency. J Appl Physiol 46:772–779
Horner RL, Innes JA, Holden HB, Guz A (1991) Afferent pathway(s) for pharyngeal dilator reflex to negative airway pressure in man: a study using upper airway anaesthesia. J Physiol (Lond) 436:31–44
White DP, Cadieux RJ, Lombard RM, Bixler EO, Kales A, Zwillich CW (1985) The effects of nasal anaesthesia on breathing during sleep. Am Rev Respir Dis 132:972–975
Hudgel DW (1986) Variable site of airway narrowing among obstructive sleep apnea patients. J Appl Physiol 61: 1403–1409
Guilleminault C, Hill MW, Simmons B, Dément WC (1978) Obstructive sleep apnea: electromyographic and fiberoptic studies. Exp Neurol 62:48–67
Wilhoit SC, Suratt PM (1987) Effect of nasal obstruction on upper airway muscle activation in normal subjects. Chest 92:1053–1055
Zwillich CW, Picket C, Hanson FN, Weil JV (1981) Disturbed sleep and prolonged apnea during nasal obstruction in normal men. Am Rev Respir Dis 124:158–160
Basner RC, Simon PM, Schwartzstein RM, Weinberger SE, Weiss JW (1989) Breathing route influences upper airway muscle activity in awake normal adults. J Appl Physiol 66:1766–1771
Prengel AW, Lindner KH, Hähnel J, Ahnefeld FW (1991) Endotracheal and endobronchial lidocaine administration: effects on plasma lidocaine concentration and blood gases. Crit Care Med 19:911–915
Katz RL, Gissen AJ (1969) Effects of intravenous and intra arterial procaine and lidocaine on neuromuscular transmission in man. Acta Anaesth Scand [Suppl] 36:103–13
McLean JA, Mathews KP, Ciarkowski AA, Brayton PR, Solomon WR (1976) The effects of topical saline and isoproterenol on nasal airway resistance. J Allergy Clin Immunol 58:563–574
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Beydon, L., Lorino, A.M., Verra, F. et al. Topical upper airway anaesthesia with lidocaine increases airway resistance by impairing glottic function. Intensive Care Med 21, 920–926 (1995). https://doi.org/10.1007/BF01712333
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01712333