ad been administered at laryngoscopy and intu-

I have attenuated the hemodynamic this hypothesis, however,

as Tam et al. 5 did. Lidocaine by IV injection has for many years re-

ace in anesthetic practice as an agent with high therapeutic index useful in reducing

a variety of undesirable reflex responses to various noxious stimuli. The study by Pathak et al.’ has not

rovided data sufficient to alter one’s perception of its utility.

r of Anesthesiology mverslty School of Medicine

Department oi: Anesthesiology Abingtor-, Memorial Hospital

i. Patilak D: Slater RM, Sum Ping SST, From RP: Effects of alfentanil and lidocaine on the hemodynamic re-

Thank you for giving me an opportunity to reply r. Atkins’s letter. I would like to reiterate what I in my study--that there have been contrasting

reports regarding the efficacy of lidocaine. Dr. Atkins stated three sources that reported the efficacy of li- docaine. Chraemmer-Jorgensen et al.’ and Hamill et al.’ did not find li ocaine effective in blunting the response to laryngoscopy and intubation.

The reason we chose to administer the study drug dium and before succinylcholine felt that if we administered alfen- would not have been truly blinded

nt may have demonstrated certain ty7 apnea, or somnolence. iewpoint, I agree with Dr. Atkins

&at rapid-sequence induction implies administration ~~~~~~~~0~~~~ following thiopental sodium, but a ciinical standpoint, I do not think that it mat-

ters if the process is delayed a few seconds by the a~rnin~s~ra~~o~ of a study drug. In conclusion, it is my

spmses ;o >aryngoscopy and tracneai iniubation. J Clin An&h 1990;2:81-5.

2. Stoeiting RK: Blood pressure and heart rate changes during short duration iaryngoscopy for tracheal intu- bation. Influence of viscous or intravenous lidocaine. Anesth Analg 1978;57:197-200.

3. Stoeiting RK: Circulatory changes during direct laryn- goscopy with or without prior lidocaine. An&esiology 1977;47:381-3.

4. Abou-Madi MN, Keszler N, YacoubJM: Cardiovascular reactions to laryngoscopy and trachea! incubation fol- lowing small and large intravenous doses of lidocaine. Can AnaestF, Sac J 1977;24:12-9.

5. Tam S: Chung F, Campbell h/i: Intravenous lidocaine: Optimal time of injection before trachea% intubation. Anesth Analg 1987;66: 1036-g.

3. Pate1 RI, Peterson RG, Aldrete JA: Endotracheal com- pared with intravenous injection of 3 mgkg of ligno- caine. Anaesthesia 1981;36:7’72-4.

7. Scott JC, Pouganis KV, Stanski D : EEG quantitalion of narcotic effect: the comparative pharmacodynamics of fentanyl and alfentanil. A~est~~si~~e~ 1985;62:234-41.

ciimcal impression that lidocaine administered 3 min- utes before 1aryngos”copy and intubation is more ef- ficacious than when it is administere at I or 2 minutes.

epartment of Anesthe University of Nebraska Omaha, NE 68105

?. Chracmmer-Jorgensen oilurnd-Carlsen P, arvig J, Christensen V: Lack of effect of IV lidocaine on hemo- dynamic responses to rapid sequence induction of gen- eral anesthesia: a double-blind controlled clinical trial. &zesth Ana?g 1986;65:1037-41.

2. Hamill JF; Bedford RF, Weaver DrC, Calalnan AR: Li- docaine before endotracheal i~~u~a~~o~: intravenous or 1aryngotracheal? Anesthesiology ~981;55:578--8! ~