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Is there any Level A evidence of the role of lignocaine in patients with severe head injury to prevent increased ICT,please give us the reference if known.

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Hi there
It is not entirely clear from your query if you are considering the use of Lignocaine as pre-treatment before RSI in a patient with severe head injury to prevent any further rise in ICT (or, are you after another group of patients. If so, may be worthwhile forming a 'three-part' question, as per Sackett's principle, before evidence-seeking process!!!)

Assuming this is what you are after, there are no studies directly answering the question posed. From what evidence is available, there is no convincing evidence in favour of lignocaine (used as a pre-treatment drug) to prevent rise in ICT (see references 1-6 below) during RSI.

These studies also could not recruit large number of patients. There are also a lot of reviews (not 'systematic' though!!!) on this topic that you could go through (try googling)

I certainly haven't used it so far in such situations. Simple measures like opening the 'cervical hard collar' with in-line immobilisation, slight head-end elevation, adequate pre-oxygenation, good glycaemic control and ETCO2 (end-tidal CO2) control would go a long way in reducing any secondary hypoxic cerebral insult.

References:

1. Prevention of arterial pressure and intracranial pressure increase during endotracheal intubation in neurosurgery: esmolol versus lidocaine. Samaha et al. Annals Fr Anesth Reanim 1996;15:36-40 (Comparative Study)

2. Lidocaine prevents increased ICP after endotracheal intubation. Bedford et al in Shulman K, Mamourou A et al eds. Intracranial Pressure IV.Berlin: Springer,1980:595-8 (RCT)

3. Lidocaine before endotracheal intubation: intravenous or endotracheal? Hamill et al Anesthesiology 1981; 55:578-81 (RCT)

4. Intravenously administered lidocaine prevents intracranial hypertension during endotracheal suctioning. Donegan et al Anesthesiology 1980;52:516-18 (Randomised, double blind, crossover trial)

5. Effect of lidocaine on ICP response to endotracheal suctioning. Yano et al Anesthesiology 1986;64:651-3 (Crossover cohort study)

6. A randomised study of drugs for preventing increases in intracranial pressure during endotracheal suctioning. White et al Anesthesiology 1982;57:242-4 (RCT)