Consensus recommendations for paediatric airway topicalisation using lidocaine.

Abstract

Lidocaine is commonly used to provide airway topicalisation in children. However, there is a paucity of evidence and no guidance available on safe dosing practices. An international expert multidisciplinary, multi-society working group conducted a systematic review of the literature, followed by a three-round Delphi process to produce consensus recommendations. These recommendations aim to improve the safety of children having their airways topicalised with lidocaine. The systematic review identified 26 articles, with 21 recommendations agreed across five domains of practice: dosing; recovery; adverse reactions; institutional responsibilities; and learning from events. Evidence was limited and mainly grades C and D but the strength of the recommendations, based on the expert consensus, was mainly moderate (65-79% consensus) and strong (≥ 80% consensus). It is hoped these consensus recommendations will promote safe practice when lidocaine is used for airway topicalisation in children.