Use of Intravenous Lidocaine as an Adjunct Prior to Intubation in Patients with Traumatic Brain Injury: A Scoping Review of the Available Evidence
DOI:
https://doi.org/10.71112/r0z9s483Keywords:
Traumatic brain injury, Intravenous lidocaine, Endotracheal intubation, Rapid sequence intubation, intracranial pressure, Cerebral perfusion pressure, Hemodynamic response, Airway management, Neurocritical patientAbstract
Traumatic brain injury (TBI) is a major cause of morbidity and mortality, in which endotracheal intubation represents a critical intervention to secure the airway and prevent secondary brain injury. However, laryngoscopy and intubation may trigger a sympathetic response that increases intracranial pressure (ICP) and compromises cerebral perfusion pressure (CPP). In this context, intravenous lidocaine has been used as an adjunct prior to intubation with the aim of attenuating these physiological effects. The objective of this study was to map the available evidence on its use in patients with TBI through a scoping review.
A scoping review was conducted following the methodological framework proposed by Arksey and O'Malley and reported in accordance with PRISMA-ScR. A systematic search was performed across major biomedical databases, identifying 500 records, of which 20 studies met the inclusion criteria. The included studies were heterogeneous in terms of design, population, and clinical setting. Most studies evaluated immediate physiological outcomes, such as changes in ICP, CPP, and hemodynamic parameters, with limited assessment of clinically relevant outcomes.
The findings suggest that intravenous lidocaine may partially attenuate the intracranial and hemodynamic response associated with intubation; however, these effects are inconsistent and do not clearly translate into meaningful clinical benefits. The available evidence is limited and largely indirect, often derived from settings different from acute TBI management in emergency scenarios. Therefore, there is insufficient evidence to support the routine use of intravenous lidocaine as pretreatment during rapid sequence intubation, highlighting the need for high-quality studies focused on clinically relevant outcomes.
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Acquisto, N. M., Mosier, J. M., Bittner, E. A., Patanwala, A. E., Hirsch, K. G., Hargwood, P., Oropello, J. M., Bodkin, R. P., Groth, C. M., Kaucher, K. A., Slampak-Cindric, A. A., Manno, E. M., Mayer, S. A., Peterson, L. K. N., Fulmer, J., Galton, C., Bleck, T. P., Chase, K., Heffner, A. C., … Murray, M. J. (2023). Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient. Critical Care Medicine, 51(10), 1411–1430. https://doi.org/10.1097/CCM.0000000000006000
Andrew Levitt, M., & Dresden, G. M. (2001). The Efficacy of Esmolol versus Lidocaine to Attenuate the Hemodynamic Response to Intubation in Isolated Head Trauma Patients. In ACADEMIC EMERGENCY MEDICINE (Vol. 8, Number 1).
Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology: Theory and Practice, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616
Brown, C. A., Kaji, A. H., Fantegrossi, A., Carlson, J. N., April, M. D., Kilgo, R. W., & Walls, R. M. (2020). Video Laryngoscopy Compared to Augmented Direct Laryngoscopy in Adult Emergency Department Tracheal Intubations: A National Emergency Airway Registry (NEAR) Study. Academic Emergency Medicine, 27(2), 100–108. https://doi.org/10.1111/acem.13851
Cocenza Varrichio Crispim, M., Otsuki, D. A., Vicentini, Y. F., Rodrigues, D. R. P., Egúsquiza, M. G. P., & Junior, J. O. C. A. (2026). Effect of lidocaine and magnesium sulfate on rocuronium onset time: a randomized controlled experimental study. Brazilian Journal of Anesthesiology (English Edition), 76(1). https://doi.org/10.1016/j.bjane.2025.844696
Collins, J., & O’Sullivan, E. P. (2022). Rapid sequence induction and intubation. In BJA Education (Vol. 22, Number 12, pp. 484–490). Elsevier Ltd. https://doi.org/10.1016/j.bjae.2022.09.001
Farrell, N. M., Killius, K., Kue, R., Langlois, B. K., Nelson, K. P., & Golenia, P. (2020). A Comparison of Etomidate, Ketamine, and Methohexital in Emergency Department Rapid Sequence Intubation. Journal of Emergency Medicine, 59(4), 508–514. https://doi.org/10.1016/j.jemermed.2020.06.054
Fathy, S., Hasanin, A., Mostafa, M., Ramzy, E., Sarhan, K., Almenesey, T., Safina, A. G., Hosny, O., Hamden, G. A., Gado, A. A., & Mokhtar, A. (2021). The benefit of adding lidocaine to ketamine during rapid sequence endotracheal intubation in patients with septic shock: A randomised controlled trial. Anaesthesia Critical Care and Pain Medicine, 40(1). https://doi.org/10.1016/j.accpm.2020.06.017
Fjærestad, T., Øyrås, P., Solbakk, K. I., & Leonardsen, A.-C. L. (2025). Upper airway discomfort: a randomized controlled double-blind trial comparing rocuronium and lidocaine spray for intubation. European Journal of Medical Research, 30(1). https://doi.org/10.1186/s40001-025-02798-8
Garcia, S. I., Sandefur, B. J., Campbell, R. L., Driver, B. E., April, M. D., Carlson, J. N., Walls, R. M., & Brown, C. A. (2023). First-Attempt Intubation Success Among Emergency Medicine Trainees by Laryngoscopic Device and Training Year: A National Emergency Airway Registry Study. Annals of Emergency Medicine, 81(6), 649–657. https://doi.org/10.1016/j.annemergmed.2022.10.019
Hampton, J. P., Hommer, K., Musselman, M., & Bilhimer, M. (n.d.). Rapid sequence intubation and the role of the emergency medicine pharmacist: Literature update.
Kaszyński, M., Kuczerowska, A., Pietrzyk, J., Sawicki, P., Witt, P., Stankiewicz, B., Darowski, M., & Pągowska-Klimek, I. (2025). Influence of intravenous lidocaine infusion on haemodynamic response to tracheal intubation and metabolic-hormonal responses during laparoscopic procedures in children: a randomised controlled trial. BMC Anesthesiology, 25(1). https://doi.org/10.1186/s12871-024-02885-z
Ketata, S., Maktouf, Y., Zouche, I., Feki, S., Keskes, M., Trigui, A., Akrout, A., Daoud, R., Chaabouni, A., & Cheikhrouhou, H. (2024). Intravenous versus intracuff alkalinized lidocaine to prevent postoperative sore throat: a prospective randomized controlled trial. Pan African Medical Journal , 48. https://doi.org/10.11604/pamj.2024.48.18.40317
Khalil, H., Bennett, M., Godfrey, C., McInerney, P., Munn, Z., & Peters, M. (2019). Evaluation of the JBI scoping reviews methodology by current users. International Journal of Evidence-Based Healthcare. https://doi.org/10.1097/XEB.0000000000000202
Larsen, M. H., Rosenkrantz, O., Knudsen, R. L., Hesselfeldt, R., Hilberg, O., Siersma, V., Heiberg, J., Rasmussen, L. S., & Isbye, D. (2025). Analgesic Effect of Cocaine and Lidocaine/Xylometazoline in Healthy Volunteers Undergoing Awake Nasal Intubation: A Randomized Controlled Crossover Trial. Acta Anaesthesiologica Scandinavica, 69(6). https://doi.org/10.1111/aas.70056
Li, X., Wen, X., Liu, Y., Zeng, S., & Wang, F. (2025). Effects of dyclonine mucilage and compound lidocaine cream as tracheal catheter lubricant on postoperative pharyngeal complications after general anesthesia. International Journal of Surgery, 111(9), 6181–6190. https://doi.org/10.1097/js9.0000000000002736
Liu, H.-B., Zheng, T., Zhong, M.-L., Liang, W.-D., Yang, W.-Y., Li, Z.-L., Liu, X., Deng, X.-J., & Chen, L. (2026). Dexmedetomidine with lidocaine topical anesthesia reduces emergence agitation and postoperative pain after pediatric tonsillectomy. Scientific Reports. https://doi.org/10.1038/s41598-025-34802-w
Lu, J., Tian, W., Cui, L., Cai, B., Zhang, T., Huang, N., Lu, L., & Zhu, T. (2021). Lidocaine-eluting endotracheal tube effectively attenuates intubation related airway response. Annals of Translational Medicine, 9(10), 871–871. https://doi.org/10.21037/atm-21-1930
Manouchehrian, N., Abbasi, R., Jiryaee, N., & Beigi, R. M. (2022). Comparison of intravenous injection of magnesium sulfate and lidocaine effectiveness on the prevention of laryngospasm and analgesic requirement in tonsillectomy. European Journal of Translational Myology, 32(4). https://doi.org/10.4081/ejtm.2022.10732
Mendonça, F. T., Silva, S. L. da, Nilton, T. M., & Alves, I. R. R. (2022). Effects of lidocaine and esmolol on hemodynamic response to tracheal intubation: a randomized clinical trial. Brazilian Journal of Anesthesiology (English Edition), 72(1), 95–102. https://doi.org/10.1016/j.bjane.2021.01.014
Peng, R., Li, H., Yang, L., Chen, X., Zeng, L., Bo, Z., & Zhang, L. (2020). Immunonutrition for traumatic brain injury in children and adolescents: Protocol for a systematic review and meta-analysis. In BMJ Open (Vol. 10, Number 9). BMJ Publishing Group. https://doi.org/10.1136/bmjopen-2020-037014
Peters, M. D. J., Godfrey, C., McInerney, P., Khalil, H., Larsen, P., Marnie, C., Pollock, D., Tricco, A. C., & Munn, Z. (2022). Best practice guidance and reporting items for the development of scoping review protocols. JBI Evidence Synthesis, 20(4), 953–968. https://doi.org/10.11124/JBIES-21-00242
Pollock, D., Davies, E. L., Peters, M. D. J., Tricco, A. C., Alexander, L., McInerney, P., Godfrey, C. M., Khalil, H., & Munn, Z. (2021). Undertaking a scoping review: A practical guide for nursing and midwifery students, clinicians, researchers, and academics. Journal of Advanced Nursing, 77(4), 2102–2113. https://doi.org/10.1111/jan.14743
Qian, X. L., Li, P., Chen, Y. J., Xu, S. Q., Wang, X., & Feng, S. W. (2023). Opioid Free Total Intravenous Anesthesia With Dexmedetomidine-Esketamine-Lidocaine for Patients Undergoing Lumpectomy. Journal of Clinical Medicine Research, 15(8–9), 415–422. https://doi.org/10.14740/jocmr5000
Rajan, S., Selvaraj, S., Roy, R. A., Sreekumar, G., Arul, L., & Mathew, J. (2026). Comparison of intubating conditions following dexmedetomidine versus midazolam nebulization during awake fiberoptic intubation. Journal of Anaesthesiology Clinical Pharmacology, 42(1), 24–29. https://doi.org/10.4103/joacp.joacp_612_24
Sriramka, B., Warsi, Z., & Sahoo, J. (2023). Effects of adding dexmedetomidine to nebulized lidocaine on control of hemodynamic responses to laryngoscopy and intubation: A randomized clinical trial. Journal of Anaesthesiology Clinical Pharmacology, 39(1), 11–17. https://doi.org/10.4103/joacp.JOACP_93_21
Takebe, S., Taguchi, S., Obata, N., & Mizobuchi, S. (2024). Effect of Intravenous Lidocaine on Rocuronium: A Randomized Controlled Trial. Kobe Journal of Medical Sciences, 70(4), 143–151. https://doi.org/10.24546/0100493127
Xu, J., Yuan, M., Zhou, T., Zhang, M., & Li, Y. (2025). Efficacy and Safety of Esketamine–Lidocaine for Anesthesia Induction in Elderly Patients Undergoing Elective Surgery: A Randomized Controlled Trial. Drug Design, Development and Therapy, 19, 9943–9953. https://doi.org/10.2147/DDDT.S562226
Xu, M., & Wu, C. (2024). Transient Consciousness Disorder During Emergency Cesarean Section in Patients with Labor Analgesia. International Medical Case Reports Journal, 17, 831–833. https://doi.org/10.2147/IMCRJ.S478976
Yadav, U., Kumar, A., & Gupta, P. (2021). A Comparative Study of Airway Nerve Blocks and Atomized Lidocaine by the Laryngo-Tracheal Mucosal Atomization Device (LMA MADgic) Airway for Oral Awake Fiberoptic Intubation. Cureus. https://doi.org/10.7759/cureus.15772
Yang, S. Z., Huang, S. S., Yi, W. B., Lv, W. W., Li, L., & Qi, F. (2021). Awake fiberoptic intubation and use of bronchial blockers in ankylosing spondylitis patients. World Journal of Clinical Cases, 9(23), 6705–6716. https://doi.org/10.12998/wjcc.v9.i23.6705
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