So before a case today my preceptor asked why we give lidocaine before induction. I told him it was for patient comfort to blunt the burning senstation caused by propofol. He told me, "that is absolutely the worst answer I could have picked." He was beside himself and so was I. I must have been told this before but have lost it somewhere in the recesses of my mind. I was a little annoyed how he responded but no matter, I was there to learn. So the "real" answer is, lidocaine is used to blunt the stimulus caused by laryngoscopy. I guess I always thought fentanyl and paralytics took care of that. He said reducing the burning sensation from propofol is a "side effect" of using lidocaine, not its intended purpose. The standard dose here is 60 mg of lidocaine IV.
As a side note, apparently UMKC students are notorious (according to one person) for drawing air out of an IV line and then throwing the syringe away with saline still in it. The preferred method is just pushing the saline back into the IV line. I know most of us already do that but in case you don't, now you know.
It's interesting to read this. I've been the victim of the dreaded "that's the worst answer you could give" response. It's a real shame that CRNA's can be so condescending to students, especially when most of the time the knowledge you receive regarding drugs is constantly bombarded by CRNA's biases.
ReplyDeleteI had a CRNA ask why I gave Lidocaine to a patient with a central line on induction. This was an experience CRNA, 30+ years of practice. He said, "it's going in a central line, so they won't feel it, so what's the point?" It sounds like the CRNA who scolded you would have gotten after you for NOT giving the Lidocaine to blunt the sympathetic response to laryngoscopy.
From now on, my response is, "it does two things: blunts the sympathetic response, and assists with decresing discomfort when pushing propofol". If they don't like that answer, I'd like to know why not. I'm sure some CRNA out there has some convoluted rationale, and of course, as as student, I'll be respectfully deferential.