Comparison between intravenous lidocaine and fentanyl on cough reflex and sympathetic response during endotracheal intubation in dogs

OBJECTIVE

To compare the effects of intravenous (IV) lidocaine and fentanyl on the cough reflex and autonomic response during endotracheal intubation in dogs.

STUDY DESIGN

Randomized, blinded, superiority clinical trial.

ANIMALS

A total of 46 client-owned dogs undergoing magnetic resonance imaging.

METHODS

After intramuscular methadone (0.2 mg kg^-1), dogs were randomized to be administered either IV lidocaine (2 mg kg^-1; group L) or fentanyl (7 μg kg^-1; group F). After 5 minutes, alfaxalone was administered until endotracheal intubation was possible (1 mg kg^-1 IV over 40 seconds followed by 0.4 mg kg^-1 increments to effect). Total dose of alfaxalone was recorded and cough reflex at endotracheal intubation was scored. Heart rate (HR) was continuously recorded, Doppler systolic arterial blood pressure (SAP) was measured every 20 seconds. Vasovagal tonus index (VVTI) and changes (Δ) in HR, SAP and VVTI between pre-intubation and intubation were calculated. Groups were compared using univariate and multivariate analysis. Statistical significance was set as p < 0.05.

RESULTS

Group F included 22 dogs and group L 24 dogs. The mean (± standard deviation) alfaxalone dose was 1.1 (± 0.2) and 1.35 (± 0.3) mg kg^-1 in groups F and L, respectively (p = 0.0008). At intubation, cough was more likely in group L (odds ratio = 11.3; 95% confidence intervals, 2.1 - 94.2; p = 0.01) and HR increased in 87.5% and 54.5% of groups L and F, respectively (p = 0.02). The median (range) ΔHR between pre-intubation and intubation was higher (13.1%; - 4.3 to + 55.1) in group L (p = 0.0021). Between groups, SAP and VVTI were similar.

CONCLUSION AND CLINICAL RELEVANCE

At the stated doses, whilst reducing the alfaxalone dose, fentanyl is superior to lidocaine in suppressing the cough reflex and blunting the increase in HR at endotracheal intubation in dogs premedicated with methadone.