Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Nov 11.
doi: 10.1111/pan.70077. Online ahead of print.

Topical Lidocaine During Airway Manipulation in Pediatric Anesthesia: A Systematic Review and Meta-Analysis

Elizabet Taylor Pimenta Weba  1 , Gabriel Soares de Sousa  2   3   4 , Alexandros Páris de Mesquita Ipácio  1 , Christian Ken Fukunaga  5 , Rafael Andrade Sampaio Silva  6 , Marco Antonio Figueiredo Teixeira  7 , Rafaela Machado Filardi  8 , Carolina Magalhães Costa  9   10 , Ricardo Vieira Carlos  2   3 , Britta S von Ungern-Sternberg  11   12   13   14
Affiliations
Review

Topical Lidocaine During Airway Manipulation in Pediatric Anesthesia: A Systematic Review and Meta-Analysis

Elizabet Taylor Pimenta Weba et al. Paediatr Anaesth. .

Abstract

Introduction: Lidocaine is widely used in pediatric anesthesia for airway topicalization to modulate undesirable airway and circulatory reflexes, yet its effectiveness remains unclear. Therefore, we aimed to perform a meta-analysis evaluating the impact of topical lidocaine on respiratory adverse events in children undergoing airway management.

Methods: PubMed, Embase, and Cochrane databases were systematically searched for studies comparing topical lidocaine with placebo, no intervention, or intravenous lidocaine for pediatric airway management. Statistical analysis was performed using R (version 4.4.1). Odds ratios (ORs) were used for binary outcomes and mean differences for continuous outcomes, with 95% confidence intervals (CIs) computed using a random-effects model.

Results: Fourteen randomized controlled trials comprising 1937 pediatric patients were included, of whom 917 (47%) received airway topicalization. In those receiving topical lidocaine, there was a significant reduction in the incidence of laryngospasm (OR 0.50; 95% CI 0.27 to 0.95; p = 0.033), desaturation (OR 0.49; 95% CI 0.25 to 0.98; p = 0.043), and sore throat (OR 0.31; 95% CI 0.16 to 0.58; p < 0.001). However, no significant differences were observed for bronchospasm (OR 0.50; 95% CI 0.11 to 2.35; p = 0.382), cough (OR 0.56; 95% CI 0.28 to 1.11; p = 0.099), severe cough (OR 1.30; 95% CI 0.18 to 9.51; p = 0.793), hoarseness (OR 1.41; 95% CI 0.17 to 11.96; p = 0.754), vomiting (OR 1.95; 95% CI 0.47 to 7.99; p = 0.355), and heart rate (beats/min) (MD 0.08; 95% CI -6.31 to 6.47; p = 0.98).

Conclusion: Our findings suggest that topical lidocaine may reduce the incidence of undesirable airway reflexes such as laryngospasm, desaturation, and sore throat in children undergoing airway management. However, its benefit for other perioperative respiratory adverse events requires further investigation, especially in high-risk populations.

Trial registration: PROSPERO registration number: CRD42024614863.

Keywords: adverse events; airway management; lidocaine; pediatric anesthesia; topical drug administration.

PubMed Disclaimer

References

    1. E. A. Hall, H. E. Sauer, M. S. Davis, and D. L. Anghelescu, “Lidocaine Infusions for Pain Management in Pediatrics,” Paediatric Drugs 23, no. 4 (2021): 349–359.
    1. N. M. Dave, “Premedication and Induction of Anaesthesia in Paediatric Patients,” Indian Journal of Anaesthesia 63, no. 9 (2019): 713–720.
    1. S. A. Khan and M. Matuszczak, “Management of the Pediatric Difficult Airway: New Strategies Unveiled,” Current Anesthesiology Reports 14 (2024): 417–425.
    1. N. Disma, T. Asai, E. Cools, et al., “Airway Management in Neonates and Infants: European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia Joint Guidelines,” British Journal of Anaesthesia 132 (2024): 124–144.
    1. H. A. Iliff, J. Parnell, P. A. Baker, et al., “Consensus Recommendations for Paediatric Airway Topicalisation Using Lidocaine,” Anaesthesia 80 (2025): 1237–1246.

LinkOut - more resources