I.v. lidocaine for prevention of intracranial hypertension

The mechanism by which lidocaine prevents raised ICP after endotracheal suctioning is not known. It may specifically block the cough reflex, it may cause cardiovascular depression and reduced cerebral blood flow. or it may function as a general anesthetic in a fashion similar to barbiturates. In dogs, high doses of lidocaine (15 mg/kg IV) significantly reduced CBF and CMRO₂. In the dose range of 1-2 mg/kg, IV lidocaine has a minimal effect on hemodynamics and level of consciousness, thus making it a potentially valuable adjunct in neurointensive care. When given to patients with closed head trauma who are prone to develop raised ICP, IV lidocaine, 1.5 mg/kg, does not significantly alter cardiovascular parameters, and yet is effective in both reducing ICP and in preventing intracranial hypertension associated with endotracheal suctioning.