Topical Lidocaine During Airway Manipulation in Pediatric Anesthesia
A Systematic Review and Meta-Analysis.
Paediatric anaesthesia
Submitted April 2026 by Dr Liam O'Doherty
Summary
Weba et al conducted this meta-analysis of 14 randomised controlled trials (RCTs) to evaluate the impact of topical lidocaine on perioperative respiratory events (PRAEs) in children undergoing airway management.
The purpose of the study was to include more recently published RCTs given the heterogeneity in study outcomes with topical lidocaine.
Fourteen RCTs were identified including 1937 paediatric patients, of whom 917 (47%) received airway topicalization with lidocaine. Studies were appropriately selected for the stated aims. The included studies had patient populations between 20 and 322 patients.
In those receiving topical lidocaine there was a significant reduction in the incidence of laryngospasm, desaturation and sore throat. There was no significant difference observed for bronchospasm, cough, severe cough, hoarseness, vomiting and heart rate.
Airway procedures included endotracheal intubation, laryngeal mask insertion and bronchoscopy. Lidocaine airway intervention treatments included 0.5%, 1%, 2%, 4% and 6.5% formulations in gel, cream, nebulisation and endotracheal tube cuff injection. Control group treatments included nebulised saline, saline spray, IV lignocaine plus intracuff saline, K-Y jelly, placebo drug and placebo gel.
Sub-group analyses were performed based on the following groups: lidocaine formulation type, airway intervention (endotracheal intubation or laryngeal mask), lidocaine concentration, presence of URTI, and children’s age. In the sub-group analyses, there was no difference in outcomes identified. The sub-groups may have been underpowered to identify a difference.
When conducting leave one out sensitivity analyses for the laryngospasm outcome, leaving either of three studies resulted in no significant outcome difference. For the desaturation outcome, leaving out either of three studies resulted in no significant outcome difference.
Limitations
- Heterogeneity in the lignocaine protocols.
- Lack of standardisation of definitions of desaturation and laryngospasm.
- This meta-analysis could not identify patients with high-risk factors for PRAE.
The findings suggest that topical lidocaine may reduce the risk of laryngospasm, desaturation and sore throat. The heterogeneity in interventions and control groups make it difficult to determine which intervention/s may be associated with these outcomes.
Commentary
The pooled analyses do suggest an outcome benefit of topical lidocaine for laryngospasm, desaturation and sore throat. Should I spray it, nebulise it, smear it, put in in the cuff? Should I use it for just endotracheal intubation or for LMA’s too? Should I just save it for those at higher risk of PRAEs? I’m not sure. Generalising this to our patient populations is difficult because it is not clear which lidocaine intervention would be beneficial for which airway intervention.
